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Outcomes and Complications of Selected Intercarpal Fusions Using Various Fixation Devices
Ting Zhang, MD; Henna Purewal, BS; Thomas J Carroll, MD; Gabriel Ramirez, PHD; Constantinos Ketonis, MD, PhD
University of Rochester Medical Center, Rochester, NY
Introduction: We evaluated outcomes of various fixation devices in intercarpal fusion for Scaphoid Nonunion Advanced Collapse (SNAC) wrist, hypothesizing that headless compression screw fixation is superior to staples or K-wire fixation regarding operative time, union rates, complications, reoperation rates, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores
.Materials & Methods: This retrospective cohort study, included patients over 18 treated with elective intercarpal fusion for SNAC wrist from 2014 to 2024. Out of 90 patients, 29 were excluded for undergoing total wrist fusion or scaphoid-capitate fusion. We reviewed surgical procedures, implants used, discharge disposition, hardware failure, union rates, revision, pain scores, infections, other complications, and PROMIS data. Confounding factors included age, hand dominance, gender, smoking status, diabetes, inflammatory conditions, and operation time. Mixed effects linear regression models, with a random intercept at the patient level, examined associations between PROMIS T-scores and fixation techniques while adjusting for confounding variables.
Results: The mean follow-up was 48.47 months (range 3 to 169 months). Screw fixation had the lowest complication rate (11%) and a 100% union rate. Staple fixation was used in 35 patients with a 91% union rate and a 23% complication rate. Fusion cup fixation was performed in 7 patients with an 86% union rate and a 57% complication rate. Plate and K-wire fixation had the highest complication rate (70%), despite a 0% reoperation rate, due to superficial pin site infections resolved by antibiotics. Regression analysis showed diabetes had a significant negative impact on all PROMIS domain T-scores, while smoking did not significantly affect outcomes.
Conclusions: We observed higher complication and reoperation rates with fusion cups due to hardware irritation, cartilage wear, and lunate fragmentation. Headless compression screws showed superior performance with higher union rates and lower complications. Diabetes and male gender significantly impacted PROMIS outcomes. Generally, patients fared well post-surgery with low non-union rates. Despite limitations like surgeon preference and heterogeneous data, this study provides valuable information comparing fixation devices in intercarpal fusions.
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