Article
Long-term results after total wrist fusion using the AO-plate
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Authors
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Careen Knie-Heinemann
- Klinik für Handchirurgie Bad Neustadt a.d. S., Bad Neustadt a.d. Saale, Germany
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Jörg Van Schoonhoven
- Klinik für Handchirurgie Bad Neustadt a.d. S., Bad Neustadt a.d. Saale, Germany
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Arthrodesis of the wrist is a salvage procedure for advanced arthritis with painfull destruction of the radiocarpal and midcarpal joint after failure of all conservative treatment and motion-preserving procedures. Fusion is performed to eleminate pain and therefore increase function of the hand.
The main purpose of this study was to determine long term functional result despite the loss of motion and define possible reasons for remaining pain.
Methods: Inclusion criteria for our retrospectiv study were total wrist fusion with an AO-plate and follow up of more than 10 years. Exclusion criteria were rheumatoid arthritis, congenital malformations and brachial plexus palsy. Between 2002 and 2007 214 patients underwent a total wrist fusion in our clinic, of which 71 patients were available for clinical follow-up examination, x-ray and functional self assesment using the DASH-questionnaire, the patient-rated wrist evaluation score (PRWE-G) and the short form 36 (SF 36) questionnaire. The modified Mayo wrist score was used to assess the clinical outcome. The mean follow-up of the 60 men and 11 women with an average age of 60.8 years was 11.2 years.
Results: The various scores averaged: DASH-score = 30 points, PRWE-G = 31 points modified Mayo wrist score (Krimmer score) 59 points. 70 of the 71 wrists fused primarly. In 23 cases the plate was removed. 18 x-ray demonstrated broken screws. Only 15 patients were complete pain free and the majority complained about pain during stress with a mean of 4/10. In most patients the pain wasn't reproducible during the examination.
The grip strength averaged 92% compared to the other wrist. Despite the remaining pain 98% of the patients were satisfied and 93% would undergo the operation again. Influence of various radiological and clinical factors on the functional result will further be statistically investigated.
Conclusions: Despite loss of wrist motion patients are highly satisfied with the long term result altough most patients complain about remaining pain during strong activity that could not further been defined on clinical or radiological examinations. The long term functional result with a mean of 30 points measured with the DASH score appears to be more favorable than the reported midterm results in other studies and is simular to the long term results of partial wrist fusion.
