Role of wrist arthrodesis in patients receiving double free muscle transfers for reconstruction following complete brachial plexus paralysis.

PURPOSE: We reviewed 18 patients who had received double free muscle transfers and wrist arthrodesis to determine the effect of the stiff wrist on digital motion and function.

METHODS: The patients were 15 men and 3 women with a mean age of 24 years. We determined the total active motion of the metacarpophalangeal and interphalangeal joints just before performing the arthrodesis and at final follow-up. We recorded the Disabilities of the Arm, Shoulder, and Hand functional score at the same times.

RESULTS: All of our patients showed evidence of fusion at a mean of 12 ± 2 weeks (range, 10-15 wk). The digital mean total active motion was 39° ± 21° before arthrodesis and 49° ± 25° after arthrodesis. Preoperative Disabilities of the Arm, Shoulder, and Hand scores significantly decreased after fusion. Three cases were complicated postoperatively by wound hematoma. Five patients required wrist arthrodesis hardware removal because of skin irritation.

CONCLUSIONS: Wrist fusion in patients receiving double free muscle transfers resulted in improved finger range of motion and overall hand function.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.