Document Type : CURRENT CONCEPTS REVIEW
Authors
1
Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
2
Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
3
Orthopedic Research Center, Department of Orthopedic, Hand, and Microsurgery, St.Marien Stift Medical Campus, Friesoythe, Germany
4
4 Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA 5 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/abjs.2022.65875.3154
Abstract
Painful end-stage wrist arthritis unresponsive to conservative treatment is frequently managed with total wrist
arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual
indications for TWA include inflammatory arthritis, idiopathic degenerative osteoarthritis (OA) and posttraumatic OA,
Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic
and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure
of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy
and severe ligament injuries (this procedure is carried out when all other treatment alternatives have failed to control
the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third
metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new
implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example
using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent
and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though
some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures,
peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third
carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high
as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should
remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures
requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual
in front of them.
Level of evidence: III
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