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CC BY-NC-ND 4.0 · J Wrist Surg 2024; 13(06): 516-521
DOI: 10.1055/s-0043-1776114
Scientific Article

A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

John J. Heifner 
1   Miami Orthopaedic Research Foundation, Miami, Florida
,
Robert J. Rowland
2   Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, Florida
,
Osmanny Gomez
2   Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, Florida
,
Francisco Rubio
2   Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, Florida
,
George S. Kardashian
3   Center for Bone and Joint Disease, Brooksville, Florida
› Institutsangaben
Funding None.
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Abstract

Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening.

Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications.

Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected.

Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases.

Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention.

Level of Evidence IV retrospective series.

Keywords

intramedullary nail - radiocarpal fusion - wrist arthritis - wrist arthrodesis - wrist fusion

Institutional Review Board

IRB# 1-1588149-1.


Note

This study and associated work was carried out at Miami Hand and Upper Extremity Institute and Center for Bone and Joint Disease.




Publikationsverlauf

Eingereicht: 31. Juli 2023

Angenommen: 20. September 2023

Artikel online veröffentlicht:
16. Oktober 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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