Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2023; 51(01): e041-e047
DOI: 10.1055/s-0043-1769604
Original Article

Total wrist Arthrodesis Using a Low-Profile, Variable-Angled Locked Dorsal Plate: Consolidation Rate and Complications of 85 Consecutive Cases

Article in several languages: español | English
Eduardo Farias Vasquez
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
2   Departamento de Ortopedia, Hospital São Vicente de Paulo, Rio de Janeiro, RJ, Brazil
,
Pedro Henrique Martinez Grosse Siestrup
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
,
Giovanni Vilardo Cerqueira Guedes 
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
2   Departamento de Ortopedia, Hospital São Vicente de Paulo, Rio de Janeiro, RJ, Brazil
,
Rafael Sousa Lima Barbosa
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
,
Anderson Vieira Monteiro
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
,
Arnaldo Couto
1   Departamento de Cirugía de la Mano, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, RJ, Brazil
3   Departamento de Farmacia, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brasil
› Author Affiliations Funding Statement The author(s) received no financial support for the research, authorship, and/or publication of this article.
› Further Information
   Permissions and Reprints

Abstract

Introduction Wrist arthrodesis has evolved over time with the growing use of a more rigid implant, and a resultant increase in healing rates. However, complications such as irritation of the extensor tendons have led to the development and introduction of improved low-profile implants in recent years. This study aimed to examine the factors that influence the healing of total wrist arthrodesis and the frequency of complications using a low-profile plate from the same manufacturer.

Materials and Methods This is a retrospective study analyzing the medical records and radiographs of patients who underwent wrist arthrodesis using a long or short Aptus ® 2.5 Trilock Wrist Fusion Plate (Medartis AG, Basel, Switzerland) between 2015 2021 in a single hospital. Epidemiological and clinical variables were analyzed. The Chi-square test or Fischer's Exact Test was used to compare proportions and the results, with a p-value ≤ 0.05 being considered statistically significant.

Results Of the 85 wrist arthrodesis performed, 100% consolidation was observed in an average of 4.6 months after surgery. Most patients were non-smokers (80%) men (69.4%) with a mean age of 50.7 years. The complication rate was 10,5%, all of which were resolved after a further intervention, requiring only one implant removal. The mean time of consolidation in smokers was 5.8 months and in non-smokers 4.2 months (p = 0.03). The mean time of consolidation following the long plate procedures was slightly shorter than with the use of the short plate but was without statistical significance.

Conclusion The wrist arthrodesis in the present study had a consolidation rate of 100% with a low rate of complications and without differences in results regarding graft placement, carpometacarpal joint fusion, or the demographic profiles of the patients. Smoking was associated with increased consolidation time but did not lead to nonunion.

Level of evidence IV

Keywords

wrist arthrodesis - wrist fusion - plate - consolidation rate - complications

Ethical Approval Declaration

Ethical approval to report this case was obtained from ETHICS COMMITTEE of INSTITUTO NACIONAL DE TRAUMATOLOGIA E ORTOPEDIA JAMIL HADDAD (INTO).


Informed Consent Declaration

Dismissal of free and informed consent was made.


Contributorship Details

Giovanni Guedes, Pedro Siestrup, and Rafael Barbosa wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.




Publication History

Received: 09 January 2023

Accepted: 04 May 2023

Article published online:
07 June 2023

© 2023. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Bibliografía

  • 1 de Araujo Silva B, de Souza MV, Carrasco FM, Melo GA, Barreiros LE, Labronici PJ. Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?. Rev Bras Ortop 2015; 50 (05) 578-585
    PubMedGoogle Scholar
  • 2 Hill JR, Lanier ST, Brogan DM, Dy CJ. Management of Adult Brachial Plexus Injuries. J Hand Surg Am 2021; 46 (09) 778-788
    CrossrefPubMedGoogle Scholar
  • 3 Kalb KH, Prommersberger KJ. The complete stiffening of the Wrist with the AO wrist arthrodesis plate. Oper Orthop Traumatol 2009; 21 (4–5): 498-509
    CrossrefPubMedGoogle Scholar
  • 4 Hazewinkel MHJ, Lans J, Lunn KN, Garg R, Eberlin KR, Chen NC. Complications and Factors Associated with Reoperation following Total Wrist Fusion. J Wrist Surg 2020; 9 (06) 498-508
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Wysocki RW, Cohen MS. Complications of limited and total wrist arthrodesis. Hand Clin 2010; 26 (02) 221-228
    CrossrefPubMedGoogle Scholar
  • 6 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 (06) 575-577
    CrossrefPubMedGoogle Scholar
  • 7 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 (06) 897-902
    CrossrefPubMedGoogle Scholar
  • 8 Mannerfelt L, Malmsten M. Arthrodesis of the wrist in rheumatoid arthritis. A technique without external fixation. Scand J Plast Reconstr Surg 1971; 5 (02) 124-130
    PubMedGoogle Scholar
  • 9 Campbell CJ, Keokarn T. Total and subtotal arthrodesis. J Bone Joint Surg Am 1964; 46: 1520-1533
    CrossrefPubMedGoogle Scholar
  • 10 Orbay JL, Feliciano E, Orbay C. Locked intramedullary total wrist arthrodesis. J Wrist Surg 2012; 1 (02) 179-184
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Zachary SV, Stern PJ. Complications following AO/ASIF wrist arthrodesis. J Hand Surg Am 1995; 20 (02) 339-344
    CrossrefPubMedGoogle Scholar
  • 12 Wei DH, Feldon P. Total Wrist Arthrodesis: Indications and Clinical Outcomes. J Am Acad Orthop Surg 2017; 25 (01) 3-11
    CrossrefPubMedGoogle Scholar
  • 13 Taii T, Matsumoto T, Tanaka S, Nakamura I, Ito K, Juji T. Wrist Arthrodesis in Rheumatoid Arthritis Using an LCP Metaphyseal Locking Plate versus an AO Wrist Fusion Plate. Int J Rheumatol 2018; 2018: 4719634
    CrossrefPubMedGoogle Scholar
  • 14 Berber O, Garagnani L, Gidwani S. Systematic Review of Total Wrist Arthroplasty and Arthrodesis in Wrist Arthritis. J Wrist Surg 2018; 7 (05) 424-440
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Holzbauer M, Mihalic JA, Pollak M, Froschauer SM. Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications. Life (Basel) 2022; 12 (05) 617
    PubMedGoogle Scholar
  • 16 Reigstad O, Holm-Glad T, Bolstad B, Grimsgaard C, Thorkildsen R, Røkkum M. Five- to 10-Year Prospective Follow-Up of Wrist Arthroplasty in 56 Nonrheumatoid Patients. J Hand Surg Am 2017; 42 (10) 788-796 DOI: 10.1016/j.jhsa.2017.06.097.
    CrossrefPubMedGoogle Scholar
  • 17 Field J, Herbert TJ, Prosser R. Total wrist fusion. A functional assessment. J Hand Surg [Br] 1996; 21 (04) 429-433
    CrossrefPubMedGoogle Scholar
  • 18 Moneim MS, Pribyl CR, Garst JR. Wrist arthrodesis. Technique and functional evaluation. Clin Orthop Relat Res 1997; 341 (341) 23-29
    PubMedGoogle Scholar
  • 19 O'Bierne J, Boyer MI, Axelrod TS. Wrist arthrodesis using a dynamic compression plate. J Bone Joint Surg Br 1995; 77 (05) 700-704
    CrossrefPubMedGoogle Scholar
  • 20 Weiss A-PC, Hastings II H. Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J Hand Surg Am 1995; 20 (01) 50-56
    CrossrefPubMedGoogle Scholar
  • 21 Sagerman SD, Palmer AK. Wrist arthrodesis using a dynamic compression plate. J Hand Surg [Br] 1996; 21 (04) 437-441
    CrossrefPubMedGoogle Scholar
  • 22 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 (04) 355-359
    CrossrefPubMedGoogle Scholar
  • 23 Rancy SK, Ek ET, Paul S, Hotchkiss RN, Wolfe SW. Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate. J Wrist Surg 2018; 7 (02) 127-132 DOI: 10.1055/s-0037-1606257.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Hernekamp JF, Schönle P, Kremer T, Kneser U, Bickert B. Low-profile locking-plate vs. the conventional AO system: early comparative results in wrist arthrodesis. Arch Orthop Trauma Surg 2020; 140 (03) 433-439 DOI: 10.1007/s00402-019-03314-4.
    CrossrefPubMedGoogle Scholar
  • 25 Cho BH, Aziz KT, Giladi AM. The Impact of Smoking on Early Postoperative Complications in Hand Surgery. J Hand Surg Am 2021; 46 (04) 336.e1-336.e11 DOI: 10.1016/j.jhsa.2020.07.014.
    CrossrefPubMedGoogle Scholar
  • 26 Hall MJ, Ostergaard PJ, Dowlatshahi AS, Harper CM, Earp BE, Rozental TD. The Impact of Obesity and Smoking on Outcomes After Volar Plate Fixation of Distal Radius Fractures. J Hand Surg Am 2019; 44 (12) 1037-1049 DOI: 10.1016/j.jhsa.2019.08.017.
    CrossrefPubMedGoogle Scholar
  • 27 Foster BK, Barreto Rocha DF, Hayes DS, Ozdag Y, Udoeyo IF, Grandizio LC. The Impact of Smoking on Delayed Osseous Union After Arthrodesis Procedures in the Hand and Wrist. J Hand Surg Am 2023; 48 (02) 158-164 DOI: 10.1016/j.jhsa.2022.05.016.
    CrossrefPubMedGoogle Scholar