Wrist Arthrodesis with Use of Bone Mill for Bone Graft Preparation
Cara M Lorentzen, MD; Oregon Health And Science University, Portland, OR; Adam J. Mirarchi, MD; Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR
Introduction: Total wrist arthrodesis in conjunction with proximal row carpectomy and morselization of the proximal row for bone graft is a common treatment for end stage wrist arthritis. However, preparation of the proximal row by removing cartilage and soft tissues is tedious. Our group has recently instituted the use of a bone mill intraoperatively to simplify the preparation of the bone graft. We sought to evaluate if the use of a bone mill to prepare bone graft provided similar clinical outcomes as traditional graft preparation.
Materials & Methods: A retrospective chart review of patients evaluating radiographic fusion and complication rates for all patients undergoing total wrist arthrodesis by a single provider over a two year period was performed. In the first group, the proximal row was prepared in the standard fashion. In the second group, all fragments of the excised proximal carpal bones were placed in the bone mill without denuding the cartilage or removing soft tissue. This resulted in a homogenous finely milled bone graft that was then packed into the arthrodesis site.
Results: Eleven wrists in ten patients underwent total wrist arthrodesis by a single provider. One patient did not return for follow up due to travel distance and thus was excluded from our study. Of the remaining 10 wrists, 5 wrists had undergone fusion with bone graft prepared in the traditional fashion and 5 had bone graft prepared via bone mill. All wrists had radiographic evidence of fusion by 6 months. Of the traditional group, there were 4 complications of persistent pain (2 nerve related, 1 carpometacarpal joint related, 1 unknown etiology). Of the bone mill group, there were 2 complications (1 metacarpal fracture, 1 wound healing). There was no statistically significant difference in the complication rate between the groups (p= 0.12). Use of the bone mill requires a $380 disposable fine blade.
Conclusions: We conclude that the use of a bone mill to prepare graft during wrist arthrodesis is a viable technique that simplifies the procedure when compared to standard bone graft preparation while maintaining similar rates of fusion and complications. While the added expense of the bone mill blade may be a disincentive, we feel the ease of this technique and homogeneity of the prepared bone graft is a net positive.
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