Abstract
Background Total wrist fusion can be elected to relieve pain in patients with osteoarthritis
and rheumatoid arthritis. This study aimed to investigate the overall complications
and the factors associated with reoperation and soft tissue complication after total
wrist fusion.
Methods We retrospectively identified adult patients who underwent total wrist fusion using
Current Procedural Terminology (CPT) codes, International Classification of Diseases,
Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review.
We included patients (n = 215) who were treated at a single institutional system from January 1, 2002 to
January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1
years (interquartile range [IQR] =1.7–9.0). The most common indications for wrist
fusion included inflammatory arthritis (n = 66, 31%), degenerative arthritis (n = 59, 27%), and posttraumatic arthritis (n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal
spanning plate, either with a local autograft (n = 167, 78%), iliac crest autograft (n = 2, 1.0%), allograft (n = 7, 3.3%), a combination of both (n = 16, 7.4%), or without a graft (n = 23, 11%). We performed a multivariable logistic regression to evaluate factors
associated with reoperation. In addition, we performed a similar analysis to identify
the factors associated with soft tissue complication after total wrist fusion.
Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9–18).
The indications included symptomatic implants (n = 12, 27%), implant failures (n = 8, 20%), infections (n = 7, 17%), and nonunions (n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds
ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1–4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications
occurred in 20 patients (9.3%) consisting of hematomas (n = 8, 3.7%), observed blistering (n = 5, 2.3%), and observed wound dehiscence (n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95–6.4, p = 0.010) was independently associated with soft tissue complication after total wrist
fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic
hardware (n = 16, 7.4%), implant failure (n = 11, 5.1%), infection (n = 11, 5.1%), nonunion (n = 8, 3.7%), and carpal tunnel syndrome (n = 4, 1.9%).
Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience
a postoperative complication and 19% of the patients underwent a reoperation. Total
wrist fusion of the dominant hand results in higher reoperation rates. The risk of
a soft tissue complication after total wrist fusion is increased in smokers.
Keywords
arthritis - arthrodesis - fusion
