Intercarpal Arthrodesis by Dowel Bone Grafting

Abstract

Successful intercarpal arthrodesis requires a stable fusion with maintenance of correct alignment and spatial relationship of the carpus. The technique described utilizes a series of tube saws to fashion the arthrodesis bed and then insert a sized iliac crest dowel bone graft with a tight interference fit. This technique has been used in 24 patients over a two-year period in both medial and lateral column intercarpal fusions. All wrists had fused by the tenth post-operative month. The technique is precise, reproducible and technically simple with a high fusion rate and minimal donor site morbidity.

Three-Corner Midcarpal Arthrodesis and Scaphoidectomy

“…Several techniques have been described using different bone grafts for intercarpal fusions, including cancellous graft from the iliac crest or the distal radius 3,5,7,9,10 and corticocancellous grafts. 8,27 Likewise, several techniques have been described using K-wires, 2,4,5,7,9,21,28 staples, 1,2,9,19 screws, 2,28 or specially designed dorsal circular plates, which have shown very high nonunion rates up to 63% and complications as implant failures, low pain relief, and a high incidence of hardware impingement. 29Y32 If compression is achieved with screws, only small amounts of local cancellous bone graft are sufficient to ensure fusion.…”

Using Computed Tomography to Assist With Diagnosis of Avascular Necrosis Complicating Chronic Scaphoid Nonunion

“…For the group having grafting and fixation, a tube saw dowel graft technique was used, and the excised portion of the proximal pole was sent for histologic analysis. 11 For the second group, having limited wrist arthrodesis, the scaphoid was excised as part of the procedure, and the proximal pole was sent for histologic analysis.…”

Canine Carpal Joint Fusion: A Model for Four-Corner Arthrodesis Using a Porous Tantalum Implant

“…1) is analogous to the four-corner fusion in humans of the capitate, hamate, lunate, and triquetrum. A similar technique using dowel bone graft from the iliac crest has been documented by Sandow et al 16 to promote fusion in humans. On the contralateral side in each animal we created an identical defect without interposition of the implant, to serve as a control to ensure that spontaneous fusion would not occur.…”