Heifner John J, Rowland Robert J, Gomez Osmanny, Rubio Francisco, Kardashian George S
Miami Orthopaedic Research Foundation, Miami, Florida.
Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, Florida.
J Wrist Surg. 2023 Oct 16;13(6):516-521. doi: 10.1055/s-0043-1776114. eCollection 2024 Dec.
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. 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. 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. 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. 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. IV retrospective series.
总体而言，使用锁定髓内钉进行全腕关节融合术（TWF）的疗效各异，这表明需要进一步研究。目前尚不清楚准备第三腕掌关节（CMCJ）是否会降低包括远端螺钉松动在内的并发症风险。
（a）报告使用锁定髓内钉进行腕关节融合术的临床结果；（b）确定保留天然第三腕掌关节是否会导致短期并发症。
对两家机构2010年至2022年使用IMPLATE锁定钉（Skeletal Dynamics，迈阿密，佛罗里达州）固定的TWF病例进行了图表回顾。收集了临床和影像学结果。
93.8%的病例实现了影像学骨愈合，包括1例延迟愈合。患者评估的平均腕关节评分是30.4，静息时疼痛的平均视觉模拟量表评分为1.7，日常生活活动期间的平均视觉模拟量表评分为3.2。有7例远端螺钉松动（21.8%），3例翻修手术（9.4%），其中包括2例取出植入物。24例（75%）使用了长桡骨钉，3例（9%）使用了短掌骨钉。
本系列研究表明，在不将第三腕掌关节纳入融合块的情况下，使用髓内钉进行全腕关节融合术后功能良好，翻修手术率较低。远端螺钉松动的病例临床表现各异，我们目前的做法是为达到干预阈值的病例提供门诊螺钉取出术。
四级回顾性系列研究。
