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Wrist Fusion Using a New Wrist Fusion Plate: First Results
Berthold Bickert, MD; Philipp Schoenle, MD; Jochen-Frederick Hernekamp, MD; Ulrich Kneser, PhD
BG Trauma Center Ludwigshafen, Ludwigshafen, Germany

Wrist arthrodesis is a rarely needed salvage procedure for posttraumatic, degenerative, or inflammatory joint destruction. Stability used to be gained by implants crossing the wrist region from the distal radius over the carpus to the 3rd metacarpal. The 3rd carpometacarpal (CMC) joint could be spared from the fusion allowing some degree of CMC motion if the plate was removed after one year. A recently introduced plate (Medartis Aptus(TM) Wrist Fusion Plate) was designed in such a way as to spare the CMC joint without the necessity of plate removal, by extending from the distal radius to the distal carpal row only. In a retrospective study we compared the functional results of wrist fusions using one of the two systems: the Aptus(TM) wrist fusion plate extending distally not further than to the capitate, hamate, and/or trapezoid bone vs. the DePuy-Synthes(TM) LCP wrist fusion plate extending distally to the 3rd metacarpal.

Patients: 10 male patients were retrospectively included after a wrist fusion with the Aptus plate (group A). They were matched with a group (B) of 10 male patients who had had a wrist fusion with the Synthes(TM) plate in the past. In all patients, the wrist joint destruction was posttraumatic in nature, and one or multiple operations such as partial wrist fusions preceded the total wrist fusion. We assessed the course of bone healing, revision surgery, and data of functional outcome (forearm rotation, grip strength, pain VAS, DASH score, modified Mayo wrist score).

Results: Mean follow-up in group A was 17 months, age 51,8 years. Two patients of group A had a revision arthrodesis for pseudarthrosis. In the remaining 8 patients bony healing was uneventful, but three revision operations were necessary for plate removal, single screw removal and neurolysis, respectivly. Forearm rotation was unrestrained in all patients. Grip strength equalled 42% of the uninjured side (12-77%), pain VAS 5 (1-7) under heavy load, DASH 47 (11-64) and Mayo wrist score 42,5 (20-70). The functional results of group B did not differ from group A. In all patients of group A, CMC-motion was increased with a maximum of 10-0-5 extension-flexion. Initial CMC pain had resolved completely in all but one at the time of follow-up evaluation.

Conclusion: Total wrist fusion should remain a salvage procedure for exceptional cases only. The functional value of an increased CMC motion after wrist fusion with the Aptus(TM) plate has yet to be proved.

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