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Wrist Arthrodesis: Review of Current Techniques

Dr. Jebson is Assistant Professor, Hand and Microvascular Surgery, Section of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor. Dr. Adams is Professor, Division of Hand and Microsurgery, Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City.

Reprint requests: Dr. Jebson, Section of Orthopaedic Surgery, University of Michigan Medical Center, 1500 East Medical Center Drive, TC2912, Ann Arbor, MI 48109–0328.

Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. Although a variety of techniques for achieving a solid fusion have been described, the combination of rigid stabilization with a dorsal plate and autogenous cancellous bone grafting results in a high fusion rate and obviates the need for prolonged postoperative cast immobilization. Successful results with dorsal plating with or without local bone graft have recently been reported for patients with posttraumatic conditions. Rod or pin fixation is an established procedure for patients with inflammatory arthritis or a connective tissue disorder; however, plate fixation for these conditions is becoming a more acceptable alternative. Complications are relatively common and range from minor transient problems to major problems, such as wound dehiscence, infection, extensor tendon adhesions, and plate tenderness, which may require implant removal. Preoperatively, patients should be assessed for the presence of carpal tunnel syndrome, distal radioulnar joint arthritis, or ulnocarpal impaction syndrome, which may become or remain symptomatic after arthrodesis. Wrist arthrodesis results in a high degree of patient satisfaction with respect to pain relief and correction of deformity. Patients are able to accomplish most daily tasks and activities by learning to adapt to, and compensate for, the loss of wrist motion.

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