Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM): study protocol

Abstract

Background It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. Method A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. Discussion It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. Trial registration This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111–12626523. ANZCTR: ACTRN12621000169842

Artrodesis de muñeca

“…69 Conservar la movilidad carpometacarpiana en el contexto de una artrodesis total puede mejorar la fuerza de agarre y de hacer el puño, mientras que, como contrapartida, puede producirse hipermovilidad y dolor por sobrecarga de dicha articulación en una muñeca fusionada. 70 A su vez, existe división en relación con la posición que debe adoptar la mano. Normalmente, se coloca la muñeca en ligera dorsiflexión y desviación cubital para optimizar el poder de agarre.…”

“…69 Preserving carpometacarpal mobility in the context of total arthrodesis can improve grip strength and fist-making ability, but on the flip side, it can lead to hypermobility and pain due to overloading of this joint in a fused wrist. 70 Additionally, there is a division regarding the position the hand should adopt. Typically, the wrist is placed in slight dorsiflexion and ulnar deviation to optimize grip power.…”

Wrist Arthrodesis Using the Medartis Carpometacarpal Joint Sparing Plate

“…We feel that this is a minor limitation given wrist arthrodeses are reported to unite at approximately 12 weeks, and it is generally accepted that pain and function stabilize by 12 months. 14 In addition, published literature suggests that most long-term complications, such as metalware failure or nonunion, occur with a 2-year initial period after which there is long-term satisfaction with the procedure. 14,15 All patients enrolled in this study showed signs of union, and therefore, the authors continue to monitor patients to understand the functional profile of these plates.…”

“…14 In addition, published literature suggests that most long-term complications, such as metalware failure or nonunion, occur with a 2-year initial period after which there is long-term satisfaction with the procedure. 14,15 All patients enrolled in this study showed signs of union, and therefore, the authors continue to monitor patients to understand the functional profile of these plates. The authors also acknowledge that another limitation of this study was a lack of preoperative data, specifically for functional assessment and pain scores, although this is in keeping with another comparable study.…”

“…This study was not designed with a preoperative pain measurement and thus not directly comparable to the study by Meads et al 3 However, in the context of high levels of patient satisfaction, it can be inferred that wrist arthrodesis using a CMCJ sparing plates offers a promising alternative to traditional CMCJ spanning plates. Of note, Owen et al 14 performed a randomized controlled trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation. The results of this study suggest that all 18 patients were satisfied with their wrist fusion and that almost all patients (17 of 18) agreed that they would recommend the procedure to others in their situation.…”