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3-bone Intercarpal Fusion Using a Novel, Variable Angle, Radiolucent Plate
Noah Raizman, MD, MFA1; Ngozi Mogekwu Akabudike, MD2; Peter J. Evans, MD, PhD, FRCSC2; (1)Cleveland Clinic, (2)Cleveland Clinic Foundation
Cleveland Clinic, Cleveland, OH, USA

Post-traumatic wrist arthritis is a disabling condition that has many etiologies but commonly affects patients after scaphoid nonunion or scapholunate ligament injuries that remain undertreated, often for years. While multiple techniques have been used to salvage degenerative wrists, partial wrist fusions maintain carpal height, preserve motion and reliably improve pain. Prior circular fusion plates have met with high nonunion rates. We have begun using a new, variable angle, circular locking plate made from PEEK (XPODE, Tri-Med) to optimize results in our patients. This review of prospectively collected data presents our results. Over a three year period, we had 21 patients with a mean age of 58. 20 patients had Stage II-III SLAC wrist and one patient had stage III SNAC. 12/21 were dominant wrists. Mean follow up was 19.6 months. 3 of our initial patients had a 4 corner fusion and the subsequent 18 had 3-bone fusions with triquetrum and scaphoid excision. 7 patients received autologous platelet-rich tissue graft, 4 patients were bone grafted with the excised carpal bones or allograft chips, three patients had both, and the remainder had no graft material at all. The most common additional procedure performed at the same operative session was carpal tunnel release (5), followed by CMC arthroplasty (3). The mean visual analog pain scale measurement was 0.9/10 at rest and 3.1/10 with activity. Total wrist arc of motion was 75 degrees. Grip strength measured 92% of the nonoperative side. The nonunion rate was 10% (2/21), which compares favorably with other techniques of intercarpal fusion. The overall complication rate was 29%. There were no plate associated complications. Mean preoperative DASH was 73.4. Mean postoperative DASH was 18.02 (p<0.0001). There was a trend for improvement of DASH scores over time. Though multiple variations on intercarpal fusion have fared well, our study demonstrates that a 3-bone fusion with a locking, circular plate has excellent mid-term results with an acceptable complication rate and low nonunion rate. Long-term results will be needed to assess the durability of this type of fusion compared to conventional 4-corner arthrodesis with other hardware.


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