Wrist Arthrodesis with Excision of the Proximal Carpal Bones Using the AO/ASIF Wrist Fusion Plate and Local Bone Graft

Abstract

We present our series of 17 patients who underwent wrist arthrodesis with excision of the proximal row carpal bones using the AO wrist fusion plate and local bone graft obtained from the excised proximal carpal row. All patients were evaluated using a questionnaire to assess pain, function, ability to perform an occupation and satisfaction with the procedure. The mean follow-up was 17 months, at which time all the fusions had united. Clinical outcome scores showed that 14 and 15 of the 17 patients achieved good or excellent results with regard to their current condition and clinical improvement, respectively. Four patients required secondary surgery, two for fractures and two for instability of the distal radio-ulnar joint unrelated to the wrist fusion.

Wrist Arthrodesis in Cerebral Palsy

“…Hartigan et al 5 reported a 100% fusion rate in 17 patients treated with wrist arthrodesis using the Synthes Wrist Fusion Plate and PRC for a variety of degenerative conditions. A 100% fusion rate was also observed by O'Bierne et al 9 in 45 wrist fusions using a dynamic compression plate and iliac crest autograft in patients with degenerative and inflammatory arthritis.…”

“…The Wrist Fusion Plate (Synthes, West Chester, PA) provided excellent fusion rates, with an acceptable complication profile in patients with inflammatory and noninflammatory arthropathy. 5 A second variable in wrist arthrodesis techniques is the need for, and the donor source of, bone graft. Many authors recommend autogenous bone graft, such as iliac crest.…”

“…10 Using modern plating techniques, good fusion rates have been reported with excised proximal row bones as local bone graft. 5 This variable has not been studied in the treatment of spastic wrist flexion deformities.…”

“…The PRC has been advocated to improve fusion rates by decreasing the number of fusion surfaces while also providing a source of local bone graft. 5,6 In spastic wrist deformities, a PRC has the added benefit of decreasing spastic contracture by shortening the working length of the flexor tendons, thus allowing for greater deformity correction. 2,4 The hypothesis of this study is that wrist arthrodesis in the treatment of severe wrist flexion contracture due to cerebral palsy provides a safe, effective treatment in skeletally mature patients.…”

Management of Complications of Wrist Arthroplasty and Wrist Fusion

“…For total wrist fusion that addresses degenerative and post-traumatic conditions, dorsal compression plating has provided the most promising results with regards to high union rates and is therefore considered the standard (24,(48)(49)(50)(51)(52). However, in cases of inflammatory arthritis, there is increased concern for implant failure with plating due to poor bone quality, in addition to concerns with wound healing.…”