Novel Use of Distal Radius Plates for Wrist Arthrodesis in Upper Limb Spasticity

Abstract

Wrist arthrodesis is commonly performed in patients with upper limb spasticity. The main benefits described in literature are improved wrist position, flexion crease hygiene and appearance [1][2][3][4]. Reported disadvantages and associated complications can be prominence of the plate, pain, periprosthetic fractures, malunion and implant loosening [1,3,[5][6][7][8]. Many patients with spasticity have smaller bones for age due to disuse and poor nutrition. The commonly available implants are often designed for arthritic or post-traumatic reconstruction. As such they are larger in size contributing to the associated complications of implant prominence, larger screw sizes leading to periprosthetic fractures and tendon irritation. Some implants are fixed across long metacarpal length leading to metacarpal extension and distal implant prominence associated with pain [1,3,[5][6][7][8].The authors hypothesized that lower profile implants with smaller screw size along with avoidance of distal fixation to the middle finger metacarpal will lead to significantly lower complication rates and improved patient compliance. After review of currently available implants we decided on the variable angle locking volar distal radius plates (Medartis®, Basel, Switzerland) for fixation in our spastic wrist arthrodeses surgeries where they are placed dorsally. This paper shares the preliminary results of our experience. The aim of the study was to evaluate any improvement in patient reported outcomes and the incidence of wrist fusion related complications using this device. Material and MethodsA retrospective study was conducted that included review of patients operated at Whiston Hospital and Alder Hey Hospital, Liverpool, Merseyside, UK under a single lead surgeon.