A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion

Background  In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose  Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods  A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results  Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion  The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence  IV retrospective series.