Hardware-Related Complications Following Radiocarpal Arthrodesis Using a Dorsal Plate

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

Note

Research performed at University of Cincinnati Department of Orthopaedic Surgery.

• References

• 1 Jebson PJ, Adams BD. Wrist arthrodesis: review of current techniques. J Am Acad Orthop Surg 2001; 9 (1) 53-60
• 2 Hayden RJ, Jebson PJ. Wrist arthrodesis. Hand Clin 2005; 21 (4) 631-640
• 3 Zachary SV, Stern PJ. Complications following AO/ASIF wrist arthrodesis. J Hand Surg Am 1995; 20 (2) 339-344
• 4 Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26 (2) 221-228
• 5 De Smet L, Truyen J. Arthrodesis of the wrist for osteoarthritis: outcome with a minimum follow-up of 4 years. J Hand Surg [Br] 2003; 28 (6) 575-577
• 6 Hastings II H, Weiss AP, Quenzer D, Wiedeman GP, Hanington KR, Strickland JW. Arthrodesis of the wrist for post-traumatic disorders. J Bone Joint Surg Am 1996; 78 (6) 897-902
• 7 Mannerfelt L, Malmsten M. Arthrodesis of the wrist in rheumatoid arthritis. A technique without external fixation. Scand J Plast Reconstr Surg 1971; 5 (2) 124-130
• 8 Campbell CJ, Keokarn T. Total and subtotal arthrodesis. J Bone Joint Surg Am 1964; 46: 1520-1533
• 9 Clendenin MB, Green DP. Arthrodesis of the wrist—complications and their management. J Hand Surg Am 1981; 6 (3) 253-257
• 10 Bracey DJ, McMurtry RY, Walton D. Arthrodesis in the rheumatoid hand using the AO technique. Orthop Rev 1980; 9: 65-69
• 11 Nagy L, Büchler U. AO-wrist arthrodesis: with and without arthrodesis of the third carpometacarpal joint. J Hand Surg Am 2002; 27 (6) 940-947
• 12 Bolano LE, Green DP. Wrist arthrodesis in post-traumatic arthritis: a comparison of two methods. J Hand Surg Am 1993; 18 (5) 786-791
• 13 Richards RR, Patterson SD, Hearn TC. A special plate for arthrodesis of the wrist: design considerations and biomechanical testing. J Hand Surg Am 1993; 18 (3) 476-483
• 14 Houshian S, Schrøder HA. Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases. J Hand Surg [Br] 2001; 26 (4) 355-359