Abstract

Wrist arthrodesis is commonly performed to improve wrist position, flexion crease hygiene and appearance in patients with spastic upper limbs. These patients often have smaller bones and large commercially available implants lead to complications such as prominence of plate, pain and periprosthetic fractures. Authors hypothesized that Medartis® distal radius plates will lead to lower complication rates on account of lower profile, variable angle locking construct and smaller screw size.
A retrospective study included review of upper limb spasticity patients who had undergone wrist arthrodesis under a single lead surgeon with a follow up period of 33 months. Medartis® distal radius volar locking plate was placed dorsally for the wrist fusion surgery along with proximal row carpectomy. 8 wrist arthrodeses were performed in 7 patients using the described technique and implant. The mean age of the patient group was 28 (16-75) years and mean follow up was 15.4 (2-33) months. 91.6o (76o-110o) mean improvement in wrist position was achieved after surgery. Fusion was achieved in all cases providing a 100% fusion rate. Visual Analogue Scale and House scores were used to assess outcomes. Maximum improvement was reported in appearance of the wrist, hygiene and overall satisfaction. There were no periprosthetic fractures and none of the implants had to be removed.
Low profile distal radius volar locking plates can be safely used for wrist fusion in upper limb spasticity with excellent outcomes. For the patient group, the Medartis® distal radius volar locking plate appears to produce superior results with low complication rates when compared to available standard fusion plates used in other series.

Keywords: Wrist arthrodesis; Cerebral palsy; Upper limb spasticity; Distal radius plates

AbbreviationsEPL: Extensor Pollicis Longus; FCR: Flexor Carpi Radialis; FCU: Flexor Carpi Ulnaris;VAS: Visual Analogue Scale