Wrist Fusion in Posttraumatic Brachial Plexus Palsy

Terzis, Julia K.; Barmpitsioti, Antonia

doi:10.1097/prs.0b013e3181bcefe0

Cited by 20 publications

(14 citation statements)

References 53 publications

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“…Our high fusion rate is comparable to the 95% fusion rate (510/539) reported in the wrist literature. 2,[4][5][6][7][8]11,18,[21][22][23][24][25][26][27][28][29] Avoidance of CMC fusion with this alternative and intuitive technique has the advantage of preserving some CMC motion, which is important to grip strength, and may be of benefit in daily and recreational activities. 29,30 Furthermore, use of a lowprofile nonspanning plate may lower complication rates and have cosmetic appeal to patients.…”

Section: Discussionmentioning

confidence: 99%

Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Rancy

Paul

et al. 2017

Jnl Wrist Surg

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This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique. A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of 15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy, psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary outcomes included time to union, patient-rated wrist evaluation score, numerical rating scale pain score, grip strength, and complications. All the wrists got fused. There were no significant differences in objective and subjective outcomes between cohorts. There were three complications (27%) in the spanning group, including tendon rupture and peri-implant fracture at the third metacarpal. This was compared with three complications (20%) in the nonspanning group, consisting of hardware removal. We achieved similar fusion rates employing both spanning and nonspanning total wrist arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter. Complications associated with our method were comparably less severe than those reported in the literature. We advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. Therapeutic level IV.

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Section: Discussionmentioning

confidence: 99%

Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Rancy

Paul

et al. 2017

Jnl Wrist Surg

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“…Wrist fusion is prerequisite to reconstruct the active pick-up function, but the traditional procedure performed dorsally between the third and fourth extensor sheath approach (Terzis and Barmpitsioti, 2009) widely exposes the common extensor tendons to adhesions. Patients would lose their limited function of finger extension due to adhesions, which happened in one case in our study.…”

Section: Discussionmentioning

confidence: 99%

Restoration of active pick-up function in patients with total brachial plexus avulsion injuries

Wang

et al. 2017

J Hand Surg Eur Vol

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“…Articles that included appropriate data were reviewed for bibliographic citations related to the above keywords in a secondary search for complication and return-to-work rates. Data from 11 reports were used to define complication rates for PRC 3 , 9 , 18 , 22 , 23 , 29 , 34 , 36 - 39 , and 17 were used for FCA complication rates 3 , 9 , 18 , 19 , 22 , 27 , 29 , 34 , 36 - 38 , 40 - 45 (Table I). One of these sources was a published abstract that contained data on the timing of complications following the index surgical procedures 34 .…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

et al. 2020

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Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform clinical decision-makers, we conducted a cost-effectiveness analysis comparing proximal row carpectomy (PRC) and four-corner arthrodesis (FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs, and health utilities between PRC and FCA. The model used a 10-year time horizon and a 1-month cycle length, and it was evaluated from the societal perspective. Utilities and clinical parameters including transition probabilities for debridement for infection, removal of implants, conversion to total wrist arthrodesis, revision FCA, and revision total wrist arthrodesis were obtained from published literature. Timing of complications was estimated from the literature. Direct medical costs were derived from Medicare ambulatory surgical cost data, and indirect costs for missed work due to surgical procedures and complications were included. The effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis and 1-way threshold analysis for utilities were performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and greater effectiveness). The mean (and standard deviation) for the total cost and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28, respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26, respectively, for FCA. In the probabilistic sensitivity analysis, PRC dominated FCA in 57% of the 1 million iterations. The cost-effectiveness acceptability curve indicated that PRC is the most cost-effective strategy regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic sensitivity analysis. These results suggest that PRC is the optimal strategy for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Wrist Fusion in Posttraumatic Brachial Plexus Palsy

Abstract: Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.

Cited by 20 publications

References 53 publications

Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Restoration of active pick-up function in patients with total brachial plexus avulsion injuries

Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

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