Total Wrist Fusion with an Intramedullary Device: A Single-Institution Series with a Minimum of One Year Follow-Up

Abstract

Objective The primary purpose of this study was to evaluate the functional and surgical outcomes of total wrist fusion (TWF) following the use of a locked intramedullary nail (IMN).

Methods A single institution study was performed, which entailed in-person reexamination of 18 patients (n = 19 wrists), out of 35 eligible patients, who underwent TWF with an IMN from 2010 to 2017. For each patient, demographic, preoperative diagnosis, physical examination, wrist radiograph, and outcome questionnaire data were obtained. The questionnaires included the visual analog scale (VAS), quick disabilities of the arm, shoulder, and hand (QuickDASH), and Mayo Wrist Score assessments. In addition, complication and reoperation data for all TWFs with an IMN during the 2010 to 2017 period (35 patients, n _I = 38 wrists) were noted.

Results In the 18 patients, age was 47.6 ± 13.9 years, 12 (63.2%) were female, and median follow-up was 150 weeks (range: 74–294). The VAS score was 0 ± 0 in 5 of 19 wrists with rheumatoid arthritis (RA) and 1.82 ± 2.78 in 14 of 19 wrists without RA. It was found that 21 of 38 wrists (55.3%) had an implant-related complication and 5 wrists (13%) underwent a reoperation due to the implant itself.

Conclusions To date, no sufficient data are present demonstrating a clear advantage of an IMN over dorsal plating for TWF at intermediate-term follow-up. Surgeons should be knowledgeable of the several potential complications of this IMN prior to its use for TWF.

Level of Evidence This is a Level IV, therapeutic study.

Keywords

intramedullary nail - fusion - rheumatoid arthritis - total wrist fusion

Ethical Approval

This study was approved by the Biomedical Institutional Review Board of The Ohio State University.

Publication History

Received: 29 June 2020

Accepted: 22 October 2021

Article published online:
06 January 2022

• References

• 1 De Smet L, Truyen J. Arthrodesis of the wrist for osteoarthritis: outcome with a minimum follow-up of 4 years. J Hand Surg [Br] 2003; 28 (06) 575-577
• 2 Hastings II H, Weiss AP, Quenzer D, Wiedeman GP, Hanington KR, Strickland JW. Arthrodesis of the wrist for post-traumatic disorders. J Bone Joint Surg Am 1996; 78 (06) 897-902
• 3 Chin KR, Spak JI, Jupiter JB. Septic arthritis and osteomyelitis of the wrist: reconstruction with a vascularized fibular graft. J Hand Surg Am 1999; 24 (02) 243-248
• 4 Cavaliere CM, Chung KC. A systematic review of total wrist arthroplasty compared with total wrist arthrodesis for rheumatoid arthritis. Plast Reconstr Surg 2008; 122 (03) 813-825
• 5 Wei DH, Feldon P. Total wrist arthrodesis: indications and clinical outcomes. J Am Acad Orthop Surg 2017; 25 (01) 3-11
• 6 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (05) 719-725
• 7 Bain GI, Ondimu P, Hallam P, Ashwood N. Radioscapholunate arthrodesis - a prospective study. Hand Surg 2009; 14 (2-3): 73-82
• 8 Mannerfelt L, Malmsten M. Arthrodesis of the wrist in rheumatoid arthritis. A technique without external fixation. Scand J Plast Reconstr Surg 1971; 5 (02) 124-130
• 9 Fontaine C, Mouliade S, Wavreille G, Chantelot C. Wrist arthrodesis with intercalated iliac crest graft in mutilans rheumatoid arthritis. Chir Main 2014; 33 (05) 336-343
• 10 Wagner ER, Elhassan BT, Kakar S. Long-term functional outcomes after bilateral total wrist arthrodesis. J Hand Surg Am 2015; 40 (02) 224-228.e1
• 11 Clayton ML. Surgical treatment at the wrist in rheumatoid arthritis: a review of thirty-seven patients. J Bone Joint Surg Am 1965; 47: 741-750
• 12 El-Kazzi W, Robert C, Mouraux D, Feipel V, Burny F, Schuind F. Arthrodesis of the wrist with bone autograft and Hoffmann external fixation. J Hand Surg Eur Vol 2012; 37 (02) 149-154
• 13 Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am 2005; 30 (05) 932-936
• 14 Solem H, Berg NJ, Finsen V. Long term results of arthrodesis of the wrist: a 6-15 year follow up of 35 patients. Scand J Plast Reconstr Surg Hand Surg 2006; 40 (03) 175-178
• 15 Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26 (02) 221-228
• 16 Jebson PJ, Adams BD. Wrist arthrodesis: review of current techniques. J Am Acad Orthop Surg 2001; 9 (01) 53-60
• 17 Millender LH, Nalebuff EA. Arthrodesis of the rheumatoid wrist. An evaluation of sixty patients and a description of a different surgical technique. J Bone Joint Surg Am 1973; 55 (05) 1026-1034
• 18 Lee DH, Carroll RE. Wrist arthrodesis: a combined intramedullary pin and autogenous iliac crest bone graft technique. J Hand Surg Am 1994; 19 (05) 733-740
• 19 Christodoulou L, Patwardhan MS, Burke FD. Open and closed arthrodesis of the rheumatoid wrist using a modified (Stanley) Steinmann pin. J Hand Surg [Br] 1999; 24 (06) 662-666
• 20 Masada K, Yasuda M, Takeuchi E, Hashimoto H. Technique of intramedullary fixation for arthrodesis of the wrist in rheumatoid arthritis. Scand J Plast Reconstr Surg Hand Surg 2003; 37 (03) 155-158
• 21 Orbay JL, Feliciano E, Orbay C. Locked intramedullary total wrist arthrodesis. J Wrist Surg 2012; 1 (02) 179-184
• 22 Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 7: 44
• 23 Mulders MAM, Kleipool SC, Dingemans SA. et al. Normative data for the patient-rated wrist evaluation questionnaire. J Hand Ther 2018; 31 (03) 287-294
• 24 Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney III WP, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989; 14 (04) 679-687
• 25 Addosooki A, Doi K, Hattori Y, Wahegaonkar A. Role of wrist arthrodesis in patients receiving double free muscle transfers for reconstruction following complete brachial plexus paralysis. J Hand Surg Am 2012; 37 (02) 277-281
• 26 Thabet AM, Kowtharapu DN, Miller F. et al. Wrist fusion in patients with severe quadriplegic cerebral palsy. Musculoskelet Surg 2012; 96 (03) 199-204
• 27 Rizzo M, Ackerman DB, Rodrigues RL, Beckenbaugh RD. Wrist arthrodesis as a salvage procedure for failed implant arthroplasty. J Hand Surg Eur Vol 2011; 36 (01) 29-33
• 28 Field J, Herbert TJ, Prosser R. Total wrist fusion. A functional assessment. J Hand Surg [Br] 1996; 21 (04) 429-433
• 29 Gaspar MP, Kane PM, Shin EK. Management of complications of wrist arthroplasty and wrist fusion. Hand Clin 2015; 31 (02) 277-292
• 30 Boonyasirikool C, Tanakeatsakul S, Niempoog S. The metacarpal locked intramedullary nail: comparative biomechanical evaluation of new implant design for metacarpal fractures. J Med Assoc Thai 2015; 98 (Suppl. 03) S91-S95
• 31 Onuma K, Shintani R, Fujimaki H. et al. Total wrist arthrodesis with wrist fusion rod in patients with rheumatoid arthritis. Eklem Hastalik Cerrahisi 2015; 26 (01) 41-48
• 32 Nydick JA, Watt JF, Garcia MJ, Williams BD, Hess AV. Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis. J Hand Surg Am 2013; 38 (05) 899-903
• 33 Lautenbach M, Millrose M, Langner I, Eisenschenk A. Results of Mannerfelt wrist arthrodesis for rheumatoid arthritis in relation to the position of the fused wrist. Int Orthop 2013; 37 (12) 2409-2413
• 34 Houshian S, Schrøder HA. Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases. J Hand Surg [Br] 2001; 26 (04) 355-359
• 35 Reigstad O, Holm-Glad T, Thorkildsen R, Grimsgaard C, Røkkum M. Successful conversion of wrist prosthesis to arthrodesis in 11 patients. J Hand Surg Eur Vol 2017; 42 (01) 84-89