[Total wrist fusion using the AO wrist fusion plate]

Karlheinz Kalb, Karl-Josef Prommersberger
Operative Orthopädie und Traumatologie 2009, 21 (4-5): 498-509

OBJECTIVE: Arthrodesis of the wrist in order to improve functional use of the hand by reducing pain and improving grip strength.

INDICATIONS: Painful destruction of both the radiocarpal and mediocarpal joint combined with contraindications to motion-preserving procedures. Conservative treatment insufficient.

CONTRAINDICATIONS: Patients who are pain-free and satisfied with a motion-preserving procedure (e.g., Wilhelm's denervation procedure) or conservative management (casting).

SURGICAL TECHNIQUE: Dorsal approach to the wrist. Removal of destroyed articular surfaces down to cancellous bone, filling the resulting defects with cancellous bone graft taken either from the the radius or the iliac crest. Stable fixation using the AO wrist fusion plate.

POSTOPERATIVE MANAGEMENT: Immediate active motion exercises of the fingers. Below-elbow cast for 2 weeks. 6 weeks postoperatively, X-ray control to judge bony healing. Normal use of the hand in daily life but avoiding pain-provoking activities.

RESULTS: 26 (18 men, eight women) of the authors' first patients with arthrodesis of the wrist using the AO fusion plate were reexamined after a mean follow-up time of 18 months (minimum 6, maximum 32 months). The mean modified Mayo Wrist Score was 47 points (minimum 20, maximum 70 points), the DASH Score (Disabilities of the Arm, Shoulder and Hand) averaged 46 points (minimum 4, maximum 81 points). 20 of the 26 patients were satisfied, but not all patients were completely free of pain. Eight out of a total of ten patients (seven men, three women) with a bilateral wrist arthrodesis were reexamined after a mean follow-up time of 66 months (minimum 27, maximum 74 months). The DASH Score was 55 points on average (minimum 38, maximum 73 points). All patients stated that their clinical situation had improved and that they were able to manage their daily activities without help. So it can be concluded that bilateral arthrodesis of the wrist is a valuable option, if all other possibilities are exhausted.

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