Clinical performance of a locked intramedullary wrist arthrodesis nail
John J. Heifner, MD1, Robert J. Rowland, DO2, Osmanny Gomez, MD2, Francisco Rubio, MD2 and George Kardashian, MD3, (1)Miami Orthopaedic Research Foundation, Miami, FL, (2)Larkin Hospital Department of Orthopedic Surgery, Miami, FL, (3)The Center for Bone and Joint Disease, Brooksville, FL
Wrist arthrodesis (WA) provides symptom relief for patients with painful end stage wrist arthritis. Considerations for choice of fixation include implant prominence on the dorsum of the hand, the ability to maintain a functional hand position despite lack of wrist motion, and the risk of subsequent operation. Prior reports for WA with a locking nail have demonstrated predictable rates of union with variable complications across small sample reports and short terms of follow up. We present clinical and radiographic outcomes across 2 institutions for a locking nail used to treat primary WA.
A chart review from 2010-2022 was performed at two institutions for cases of wrist arthrodesis fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Data collected include indication, follow up term, the Patient-Rated Wrist Evaluation (PRWE), a visual analog scale for pain at rest (VASr) and during activities of daily living (VASa) and radiographic assessment of bony union. The criterion for union was bridging trabeculae across the fusion site on posteroanterior and lateral view.
Across 38 cases at a mean of 7 months of follow up, radiographic union was achieved in 97.3% of cases which included 1 case of delayed union. There were 7 cases (18.4%) of distal screw migration, of which 5 reported minimal pain. There were 2 cases (5.2%) with radiographic evidence of implant loosening without corresponding clinical symptoms. The mean PRWE was 37 at a mean follow up of 38 months. One implant was removed at 8 months postoperatively in a patient with rheumatoid arthritis. There was no evidence of infection, and the implant was radiographically stable. The patient presented with pain and swelling of undetermined cause, that may be secondary to the underlying condition.
The current results demonstrate high rates of radiographic union and satisfactory clinical outcomes following wrist arthrodesis with a locking nail. Cases with radiographic evidence of distal screw migration did not display concerning symptoms. The PRWE scores indicate that satisfactory function can be attained when the hand is placed in a functional position despite the absence of wrist motion. The third carpometacarpal joint was not included in the arthrodesis preparation in this series. Further investigation is needed to determine if arthrodesis preparation of the third carpometacarpal joint can mitigate implant loosening due to reduced forces across the fixation construct.
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