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Early Results of Partial Wrist Arthrodesis with PEEK-Optima Circular Plates
Ngozi Mogekwu Akabudike, MD; Peter J. Evans, MD, PhD, FRCSC
Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH

Introduction: Partial wrist arthrodesis is a well described salvage operation for scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC). Capitolunate arthrodesis is an intercarpal fusion that has been shown to be comparable to other motion-preserving operative procedures for SNAC and SLAC degenerative wrist arthritis. Circular plates were introduced in 1999 and were expected to provide more stable fixation. However, circular plates have been associated with higher non-union rates and a high complication profile. We present our early outcomes of capitolunate arthrodesis with a PEEK-Optima circular plate (TriMed, Inc., Santa Clarita , CA).  

Methods: A retrospective chart review of medical records and radiographs was performed on all patients who had a capitolunate arthrodesis; scaphoid and triquetrum excision with the PEEK-Optima plate at a single institution. The plate is radiolucent and designed to allow for lagging of bone to the plate. The screws are titanium, variable angle and lock into the plate.

Early outcomes evaluated were visual analog scale (VAS) pain scores, capitolunate fusion rates and complication profile.

Results: Twenty-one patients were identified and followed clinically. The average clinical follow up was 5.4 (range 1-23) months. The average radiographic follow up was 6 (range 2-23) months. The mean VAS pain score was 0.9 at rest and 3.1 with activity. 19/21 (90%) had a solid capitolunate fusion on all xray views at the latest follow up. 1 patient has an asymptomatic  partial union. 1 patient has a nascent union that is symptomatic (5/10 pain) with activity. There were no plate related complications. 3 other complications occurred: 1 post operative carpal tunnel syndrome; 1 extensor indicis proprius  (EIP) tendon rupture and extensor pollicis longus (EPL) partial tendon rupture in a patient with pre-existing tenosynovitis; 1 persistent ulna sided wrist pain. We are currently evaluating DASH scores.  

Conclusion: The early observations of our study with a new circular partial wrist fusion plate show good fusion rates without the need for a separate bone grafting site. The promising early results with excellent pain relief and no plate associated complications are encouraging. Further data analysis of the cohort with patient outcome data (DASH) is currently being reviewed.


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