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A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion
John J Heifner1, Robert J Rowland2, Osmanny Gomez2
1Miami Orthopaedic Research Foundation, Miami, Florida.
Journal of Wrist Surgery
|December 2, 2024
Summary
Total wrist fusion using a locking intramedullary nail shows good outcomes without affecting the third carpometacarpal joint. This method offers satisfactory function and low revision rates for wrist arthrodesis.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Biomedical Engineering
Background:
- Varied efficacy of total wrist fusion (TWF) with locking intramedullary (IM) nails necessitates further research.
- The impact of third carpometacarpal joint (CMCJ) preparation on complications like distal screw loosening is not well-understood.
Purpose of the Study:
- To report clinical outcomes of wrist arthrodesis utilizing a locking IM nail.
- To investigate if preserving the native third CMCJ articulation influences short-term complication rates.
Main Methods:
- Retrospective chart review of TWF cases using the IMPLATE locking nail (2010-2022) across two institutions.
- Collection and analysis of clinical and radiographic outcomes.
Main Results:
- Achieved radiographic union in 93.8% of cases.
- Mean patient-rated wrist evaluation score was 30.4; mean pain scores at rest and during activity were 1.7 and 3.2, respectively.
- Reported seven instances of distal screw loosening (21.8%) and three revision surgeries (9.4%).
Conclusions:
- Locking IM nail TWF without CMCJ inclusion demonstrates satisfactory function and low revision rates.
- Distal screw loosening presented variably; outpatient screw removal is a current practice for symptomatic cases.
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