Wrist Arthrodesis for Brachial Plexus Palsy Using an External Fixator and a Cannulated Screw (Ioannina Technique)

Abstract

Purpose. To present a new technique for wrist arthrodesis and review its treatment outcomes in 33 patients with brachial plexus palsy. Methods. 26 men and 7 women (mean age, 26 years) with global brachial plexus palsy underwent wrist arthrodesis using an external fixator and a cannulated screw. All surgeries were performed under local anaesthesia by a single senior surgeon. An external fixator was applied to the radius and the metacarpal of the index finger. The articular surfaces of the radius, scaphoid, lunate, and capitate were debrided, and a cannulated screw inserted from the base of the radial styloid to the carpo-metacarpal joint of the ring finger. Cancellous allografts mixed with demineralised bone matrix were added to the decorticated wrist bones. The external fixator was removed at week 8 and the wrist protected with a short-arm splint until solid wrist fusion. Results. All patients achieved wrist fusion after a mean of 14 (range, 12–16) weeks. Two patients had delayed fusion and slight wrist instability, because the shorter screw was embedded in the cancellous bone and not self-tapped to the cortex. Fusion was achieved after replacement with a longer screw. No patient developed a superficial or deep wound infection; 2 developed pin track infections. All patients were satisfied with the outcome and able to perform simple daily activities after one year. Conclusion. Our new technique for wrist arthrodesis is less invasive. Blood loss, the risk of postoperative infection, and adhesions at the extensors are decreased.