Complications and Factors Associated with Reoperation following Total Wrist Fusion

Background  Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion. Methods  We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients ( n  = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7-9.0). The most common indications for wrist fusion included inflammatory arthritis ( n  = 66, 31%), degenerative arthritis ( n  = 59, 27%), and posttraumatic arthritis ( n  = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft ( n  = 167, 78%), iliac crest autograft ( n  = 2, 1.0%), allograft ( n  = 7, 3.3%), a combination of both ( n  = 16, 7.4%), or without a graft ( n  = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion. Results  Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9-18). The indications included symptomatic implants ( n  = 12, 27%), implant failures ( n  = 8, 20%), infections ( n  = 7, 17%), and nonunions ( n  = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1-4.7, p  = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas ( n  = 8, 3.7%), observed blistering ( n  = 5, 2.3%), and observed wound dehiscence ( n  = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95-6.4, p  = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware ( n  = 16, 7.4%), implant failure ( n  = 11, 5.1%), infection ( n  = 11, 5.1%), nonunion ( n  = 8, 3.7%), and carpal tunnel syndrome ( n  = 4, 1.9%). Conclusion  Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.