Abstract
Background Hardware-related complications more than 6 months after total wrist arthrodesis are
rarely reported, and controversy remains around the inclusion of the middle finger
carpometacarpal joint (CMCJ) in the fusion mass.
Purpose To determine the frequency of hardware-related complications including plate fractures,
screw fractures, and symptomatic plate/screw loosening, and to investigate whether
failure to fuse the middle finger CMCJ contributed to these hardware complications.
Patients and Methods A retrospective chart review was designed to identify long-term hardware-related
complications following 122 wrist arthrodeses using plate fixation. Patients with
at least 6 months of follow-up were reviewed to determine the number of complications,
the involvement of the middle finger CMCJ, and the procedures required to address
these complications.
Results At a median of 2.5 years following arthrodesis (range, 6 months–19 years), 20 (16%)
hardware-related complications occurred and included screw fracture (n = 12), plate loosening (n = 5), and plate fracture (n = 3). Thirteen (65%) of the hardware complications occurred after the CMCJ was not
fused during the procedure. The CMCJ did not fuse after attempted arthrodesis in 6
additional wrists.
Conclusions Persistent middle finger CMCJ micromotion was likely present in 19/20 wrists (95%)
that experienced symptomatic hardware complications. Given the occurrence of hardware
failures centering on this joint, it is our recommendation that, unless one plans
for routine plate removal within a given timeframe, the middle finger CMCJ must be
included in the fusion mass.
Level 4 Therapeutic Case Series
Keywords
wrist - arthritis - complications - arthrodesis - hardware - total wrist fusion -
carpometacarpal joint
