JBJS | Arthrodesis of the Wrist for Post-Traumatic Disorders*

The Journal of Bone & Joint Surgery, Volume 78, Issue 6

Articles | June 01, 1996

Arthrodesis of the Wrist for Post-Traumatic Disorders*

HILL HASTINGS II, M.D.†; ARNOLD-PETER C. WEISS, M.D.‡; DELWIN QUENZER, M.D.§; GEOFFREY P. WIEDEMAN, M.D.¶; KENNETH R. HANINGTON, M.D.#; JAMES W. STRICKLAND, M.D.†, INDIANAPOLIS, INDIANA

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Investigation performed at the Indiana Hand Center and the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis

The Journal of Bone & Joint Surgery. 1996; 78:897-902

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Abstract

We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a post-traumatic disorder at one center. Fifty-six patients (fifty-seven wrists) had the arthrodesis with plate fixation, and thirty-three patients (thirty-three wrists) had the arthrodesis with a variety of other techniques. The average age of the patients at the time of the arthrodesis was forty-two years, and the dominant wrist was treated in forty-two patients.Fifty-six (98 per cent) of the fifty-seven wrists that had been fixed with a plate had a successful union at an average of 10.3 weeks postoperatively. Twenty-seven (82 per cent) of the thirty-three wrists that had been treated with other methods had a successful union at an average of 12.2 weeks postoperatively. The difference in the rates of union between the wrists fixed with a plate and those treated with alternative techniques was significant (p = 0.009; Fisher exact test).A total of thirty-nine complications were associated with twenty-nine (51 per cent) of the fifty-seven arthrodeses with plate fixation. Sixteen (41 per cent) of the complications (thirteen wrists) resolved with non-operative treatment. Twenty-six (79 per cent) of the thirty-three arthrodeses with alternative methods of fixation were associated with a total of twenty-nine complications. Twenty-three (79 per cent) of those complications (twenty wrists) resolved with non-operative treatment. The difference between the rate of complications associated with the arthrodeses with plate fixation and that associated with the arthrodeses with alternative methods of fixation was significant (p = 0.03; Fisher exact test).

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Introduction

Introduction | Materials and Methods | Results | Discussion | References

The treatment of post-traumatic disorders of the wrist has changed during the previous several decades. Although operative techniques that preserve or enhance the mobility of the wrist have become popular^30,32, at times these procedures have not yielded durable results or prevented the progression of osteoarthrosis^16,22. In light of these problems, total arthrodesis of the wrist continues to represent an important operative alternative for the treatment of painful post-traumatic disorders of the wrist^1,4,6,7,10.

The operative techniques of total arthrodesis of the wrist have been modified, in particular with regard to the use of stable internal fixation^18-21. In the present study, a consecutive series of patients who had been managed with arthrodesis of the wrist at one facility were examined. Specifically, the results of the use of intercalated autogenous iliac-crest bone graft alone were compared with those of stable fixation with a plate^20,33,34.

*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

†Indiana Hand Center, 8501 Harcourt Road, Indianapolis, Indiana 46260.

‡Department of Orthopaedics, Brown University Medical School, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903.

§1440 Pleasant Street, Des Moines, Iowa 50314.

¶1201 Alhambra Boulevard, Suite 410, Sacramento, California 95816-5243.

#Group Health Associates, 8245 Northcreek Drive, Cincinnati, Ohio 45236.

*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

†Indiana Hand Center, 8501 Harcourt Road, Indianapolis, Indiana 46260.

‡Department of Orthopaedics, Brown University Medical School, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903.

§1440 Pleasant Street, Des Moines, Iowa 50314.

¶1201 Alhambra Boulevard, Suite 410, Sacramento, California 95816-5243.

#Group Health Associates, 8245 Northcreek Drive, Cincinnati, Ohio 45236.

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Figs. 1-A through 1-D: Radiographs of the wrist of a twenty-nine-year-old man who was seen with chronic pain and degenerative osteoarthrosis. Figs. 1-A and 1-B: Anteroposterior and lateral radiographs made after open reduction, bone-grafting, and internal fixation of a non-union of the scaphoid.

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Figs. 1-A and 1-B: Anteroposterior and lateral radiographs made after open reduction, bone-grafting, and internal fixation of a non-union of the scaphoid.

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Anteroposterior and lateral radiographs made after a successful arthrodesis with use of a 3.5-millimeter limited-contact dynamic compression plate. The patient had complete relief of pain and excellent function.

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Materials and Methods

Introduction | Materials and Methods | Results | Discussion | References

A retrospective review was conducted of the operative records and charts of eighty-nine consecutive patients (ninety wrists) who had had an arthrodesis of the wrist for the treatment of a post-traumatic disorder. Patients who had had the procedure for a condition related to inflammatory osteoarthrosis, a neuromuscular disorder, or a problem with a tendon or other soft tissues were excluded from the study.

The cohort of patients included eighty-two men and seven women who had an average age of forty-two years (range, twenty-three to sixty-nine years). The dominant wrist was involved in forty-two patients, and one patient had an arthrodesis in both wrists.

Thirty-eight patients performed strenuous manual labor, such as farming or construction work; thirty-six performed moderate work, such as factory assembly or operation of an industrial machine; and fifteen patients did light work, such as clerical tasks or homemaking, or were unemployed.

The indications for the arthrodesis included post-traumatic osteoarthrosis in twenty-three wrists, chronic scapholunate dissociation with pain in nineteen, intercarpal osteoarthrosis associated with advanced scapholunate collapse in sixteen and with an ununited fracture of the scaphoid in twelve, Kienböck disease associated with intercarpal osteoarthrosis in eight, failure of a previous arthrodesis in nine, and mid-carpal osteoarthrosis in three. A total of 137 operative procedures had been performed on sixty-eight of the ninety wrists before the index arthrodesis. Of these sixty-eight wrists, forty-four had had substantial complications related directly to the previous operation, including osseous non-union or fracture in twenty-six wrists, entrapment or injury of a nerve in twenty-one, failure of a silicone prosthesis in eight, infection in six, instability of the joint in two, and adhesions or subluxation of a tendon in two. Thirty-six wrists had had a total of fifty-seven reconstructive procedures to preserve some mobility. Those procedures included a limited arthrodesis in twenty-five wrists, silicone arthroplasty in seventeen, radial styloidectomy in six, reconstruction of the intercarpal ligament in four, proximal-row carpectomy in three, denervation of the wrist in one, and osteotomy for shortening of the radius for the treatment of Kienböck disease³⁴ in one.

Before arthrodesis with internal plate fixation was adopted at our institution, a variety of other methods had been used. The techniques, which had been selected primarily on the basis of the preference of the individual surgeon, included the method of Abbott et al.¹ (seven wrists), that of Abbott et al. as modified by Straub and Ranawat²⁹ (twenty-one wrists), that of Carroll and Dick⁷ (four wrists), and that of Millender and Nalebuff²¹ (one wrist).

The original¹ and modified²⁹ techniques of Abbott et al., the technique of Carroll and Dick⁷, and that of Haddad and Riordan¹³ are similar in that an autogenous corticocancellous bone graft from the iliac crest is used to bridge the entire carpus from the distal part of the radius to the bases of the second and third metacarpals. Each technique is performed through an operative exposure along the radial side of the wrist. With the modified method of Abbott et al., two stout Steinmann pins or, in some instances, smaller Kirschner wire is used to transfix the bone graft temporarily in place. The technique described by Carroll and Dick⁷ involves use of a contoured iliac-crest bone graft, two distal prongs of which are wedged into the medullary canals of the second and third metacarpals. No internal fixation is used. With the technique of Millender and Nalebuff²¹, a Steinmann pin is permanently implanted from the third metacarpal into the radius. Postoperative immobilization in a cast is necessary after use of all of these methods.

Plate fixation was performed in fifty-seven wrists. A 3.5-millimeter AO/ASIF compression plate (Synthes USA, Paoli, Pennsylvania) was used in fifty-five wrists and a 3.5-millimeter reconstruction plate, in two (Figs. 1-A, 1-B, 1-C through 1-D). A straight plate with ten holes was utilized in all but seven wrists. In these seven wrists, which either had a substantial loss of bone in the carpus or were in a patient who had small hands, a straight plate with eight holes was used. Autogenous iliac-crest bone graft was placed in the site of the arthrodesis in all but one of the wrists treated with plate fixation. A cancellous bone graft alone was used in thirty-seven wrists that had no loss of bone in the carpus or formation of bone cysts. The graft was packed into the third carpometacarpal, scaphoid-lunate-capitate, and radius-scaphoid-lunate joints after decortication of all of the articular surfaces within the wrist. In seventeen wrists that had cystic changes and bone resorption (associated with particulate synovitis because of a silicone implant in four of them), a corticocancellous iliac-crest bone graft was contoured to fit in a trough fashioned from the distal part of the radius through the dorsal aspect of the carpus to the third carpometacarpal joint. In two wrists, the unique shape of the iliac-crest bone graft necessitated the use of a more malleable plate; for this reason, the 3.5-millimeter reconstruction plate was chosen.

The fixation technique involved centering the plate over the third metacarpal in such a way as to permit three screws to be placed into the metacarpal. The configuration of most wrists affords an opportunity to affix the plate to the radius with four screws. In some wrists, an additional screw can be placed into the capitate. Early in our experience, the plate was not contoured. Therefore, in thirteen wrists, the arthrodesis was performed with the hand and wrist in the neutral position of extension and flexion. We subsequently used a contoured plate in forty-four wrists to achieve an arthrodesis with the hand and wrist in approximately 5 to 10 degrees of extension relative to the radius.

Postoperatively, the initial thirty-three wrists were immobilized in a cast for four to six weeks. As our experience developed, support for the remaining twenty-four wrists was provided only with use of a volar splint for two weeks.

Seventeen concurrent operative procedures were performed in the thirty-three wrists that had an arthrodesis without fixation with a plate. These included Darrach¹¹ resection of the distal part of the ulna in nine, removal of a silicone prosthesis from four, extensor tenolysis in three, and carpal tunnel release in one. In the fifty-seven wrists treated with fixation with a plate, thirty-four concurrent operative procedures were performed. These included resection or reconstruction of the distal aspect of the ulna in twelve; removal of a silicone prosthesis or hardware from seven; carpal tunnel release in five; excision of a neuroma in three; arthrodesis of the scaphoid-trapezium-trapezoid joint in two; and denervation of the wrist, synovectomy of the wrist, arthroscopy of the wrist, extensor tenolysis, and débridement of soft tissue and bone in one each.

At the preoperative and postoperative evaluations, a clinical history was recorded, a physical examination was performed, and radiographs were made of the involved wrist. Each patient was followed until the site of the arthrodesis was judged to be healed according to clinical and radiographic criteria. Radiographic union was considered to be complete when bone trabeculation coursed across the fusion mass without any intervening radiolucent areas. Patients were not discharged until any symptoms or complications had resolved, and none of the patients failed to keep follow-up appointments.

Statistical analysis was performed on all data with use of InStat 2.0 (GraphPad, San Diego, California). Complications (other than the failure to obtain union) were classified as those that necessitated an additional operative procedure and those that resolved with non-operative management.

Results

Introduction | Materials and Methods | Results | Discussion | References

The average duration of follow-up was thirty-two months (range, fifteen to 110 months).

Union

Fifty-six (98 per cent) of the fifty-seven wrists that had been treated with plate fixation united at an average of 10.3 weeks postoperatively. Union was achieved at an average of 12.2 weeks postoperatively in twenty-seven (82 per cent) of the thirty-three wrists treated with alternative techniques. The difference in the rate of union between the two groups was significant (p = 0.009; Fisher exact test).

In the group that had had fixation with a plate, the difference in the average time to union between the wrists that had had autogenous cancellous bone-grafting (10.2 weeks) and those that had had corticocancellous bone-grafting (10.8 weeks) was not significant, with the numbers available. The seven wrists that had non-union were treated with a secondary grafting procedure with use of cancellous bone from the contralateral iliac crest. The site of the pseudarthrosis was debrided and packed with the graft, and a short plate was applied across the site of the non-union. Union was achieved in all seven wrists, at an average of 8.9 weeks postoperatively.

Work Status

Of the eighty-nine patients who had had an arthrodesis of the wrist, ten did not return to work for reasons unrelated to the arthrodesis: they had not been employed before the arthrodesis, they had another medical disability, or they had a loss of business after the arthrodesis. Of the remaining seventy-nine patients, fifty-one returned to the same employment activities that they had performed preoperatively, twenty returned to a less strenuous occupation, and eight did not return to work because of reasons related to the wrist. These eight included four who retired.

Among the patients who returned to unrestricted work, those who had had the arthrodesis with plate fixation did so an average of 24.2 weeks postoperatively compared with an average of 40.0 weeks postoperatively for those without plate fixation. With the numbers available, the difference was not significant (p = 0.11). Of the patients who returned to less strenuous employment, those who had had an arthrodesis with a plate returned to work an average of 16.4 weeks postoperatively compared with an average of 27.0 weeks postoperatively for the group managed with alternative techniques. Again, the difference was not significant (p = 0.06).

Complications

A total of thirty-nine complications were associated with twenty-nine (51 per cent) of the fifty-seven arthrodeses performed with plate fixation. Twenty-six (79 per cent) of the thirty-three arthrodeses performed with use of an alternative technique were associated with a total of twenty-nine complications. The difference in the rate of complications was significant (p = 0.03; Fisher exact test).

Twenty-three complications associated with sixteen arthrodeses performed with plate fixation were treated with an operative procedure. These complications included tenosynovitis of the extensor tendons (seven wrists); contracture of intrinsic muscles (four); compression of the median nerve in the carpal tunnel (four); adhesions of the flexor or extensor tendons (three); osteoarthrosis of the joint (two); and reflex sympathetic dystrophy, rupture of the extensor tendon, and fracture of the iliac crest with formation of a hernia (one each). Six complications associated with six arthrodeses performed with an alternative method of fixation were treated operatively. These included adhesions of the flexor or extensor tendon (two wrists), compression of the median nerve in the carpal canal (two), and dysfunction of the distal radio-ulnar joint and infection of an iliac-crest bone graft (one each).

Sixteen complications associated with thirteen arthrodeses performed with plate fixation were managed without operative intervention. These complications included problems with healing of the operative wound (four wrists), tenderness over the plate (four), compression neuropathy at the carpal tunnel (two), pain at the iliac-crest donor site (two), stiffness of the digits (two), and a fracture of a metacarpal and a traumatic neuroma of a branch of the ulnar sensory nerve (one each). Twenty arthrodeses performed with alternative techniques were associated with twenty-three complications that resolved with non-operative treatment. These included a local infection around a fixation pin (ten wrists), stiffness of a digit (three), pain at the iliac-crest donor site (three), pain at the distal radio-ulnar joint (three), a traumatic neuroma of a branch of the radial sensory nerve (two), and transient symptoms of compression of the median nerve in the carpal tunnel and a wound infection at the wrist (one each).

Discussion

Introduction | Materials and Methods | Results | Discussion | References

Arthrodesis of the wrist is a well established reconstructive procedure that has proved successful for the treatment of a number of disorders. One of the most notable trends in association with this procedure has been the increasing use of internal fixation in order to decrease the need for prolonged immobilization in a cast postoperatively. Robinson and Kayfetz²⁴, in 1952, used a single screw, and other investigators have used multiple screws, to hold the cortical bone graft in place in the dorsal aspect of the wrist^14,25,26. The use of a single Kirschner wire to supplement immobilization in a cast and aid in the achievement of a solid fusion of the wrist has been identified in several case reports^5,8,12,13. In 1965, Clayton⁸ devised a method for performing arthrodesis of the wrist, in patients with rheumatoid arthritis, with use of a single permanent Steinmann pin advanced retrograde from the third metacarpal into the medullary canal of the radius. In 1971, Mannerfelt and Malmsten¹⁹ treated patients who had rheumatoid arthritis with a similar technique, except that they employed a Rush rod, with supplementary staple fixation eliminating the need for postoperative immobilization in a cast. In 1973, the results of a modification of this technique by Millender and Nalebuff²¹ supported the finding that immobilization in a plaster cast was not imperative after arthrodesis of a rheumatoid wrist when internal fixation was used. The technique of Mannerfelt and Malmsten¹⁹, with or without the removal of the pin after the consolidation of bone, also has been used for arthrodesis of wrists with post-traumatic disorders. Other methods of internal fixation have included the use of multiple staples without an intramedullary pin and the technique of placing a pin from the thenar eminence into the medullary canal of the radius without exposing the wrist^2,23,27. In 1972, Meuli²⁰ described the dorsal placement of a nine-hole plate, from the second metacarpal to the radius, with an additional corticocancellous autogenous iliac-crest bone graft. In 1974, this technique was described by Larsson¹⁷, who used a six-hole self-compressing plate. Manetta and Tavani¹⁸, in 1975, advocated axial compression, with the plate fixed distally to the third metacarpal, without the use of secondary bone-grafting. By the early 1980's, a larger eight-hole 3.5-millimeter dynamic compression plate was advocated to provide more appropriate rigid fixation of the arthrodesis site^4,15,17,36. The use of corticocancellous bone graft from the iliac crest was still advocated to augment the site of the arthrodesis, for appropriate osseous consolidation. Some have cautioned that the use of a compression plate could lead to problems at the distal part of the ulna due to impaction of the ulnar head against the carpus²⁸.

The rates of osseous union after arthrodesis of the wrist for post-traumatic conditions can be difficult to interpret from reports in the literature. The results of our study indicate that dorsal fixation with a plate and augmentation with bone graft provides a far more predictable rate of fusion than techniques without plate fixation. With the numbers available, we found no significant difference in the rates of union between procedures involving the use of cancellous iliac-crest graft alone and those involving the use of corticocancellous bone-block graft from the iliac crest. As most of the problems at the iliac-crest donor site were related to the attainment of corticocancellous segments, it appears prudent to use cancellous bone graft alone when augmenting dorsal fixation with a plate in an arthrodesis of the wrist. Cancellous bone graft can be obtained through a much smaller incision, reducing the potential morbidity from fracture of the iliac crest, hernia, a painful neuroma, or a palpable deformity. It does not appear that postoperative immobilization in a cast is necessary, although it may be appropriate for patients who are having certain concomitant procedures such as resection of the distal aspect of the ulna.

Several important points are illustrated by the results of the present study. Before an arthrodesis of the wrist is performed, the patient should be carefully evaluated for problems related to the distal radio-ulnar joint. When such problems occur after arthrodesis of the wrist, they may be due to mechanical alterations from the arthrodesis itself or they may be concurrent conditions that were not recognized because of the apparent pain and disability at the radiocarpal joint. Particular attention should also be paid to the presence of compression of the median nerve at the carpal tunnel. Secondary symptoms of carpal tunnel syndrome may represent an alteration in the normal anatomy of the carpal tunnel after arthrodesis of the wrist.

Our technique incorporated the third carpometacarpal joint in the arthrodesis of the wrist. We did not attempt to include the second carpometacarpal articulation. Abbott et al.¹ cited the importance of carpometacarpal flexion and rotation in power grip, and Urbaniak³¹ noted that carpometacarpal mobility may actually increase, as a compensatory mechanism, after arthrodesis of the wrist. Brittain³ contradicted the theory of Abbott et al. that inclusion of the carpometacarpal joint in arthrodesis causes loss of grip strength; they observed that full flexion of the fingers and power grip were not impeded by inclusion of the carpometacarpal joint in total arthrodesis. In the present study, three patients had a painful non-union at the site of a carpometacarpal arthrodesis. All were managed with a second operative procedure (arthrodesis with bone-graft augmentation) to achieve fusion of the carpometacarpal joint and avoid pain. As we now do not routinely remove the dynamic compression plate, possible metal fatigue and failure of the plate over a mobile articulation would be a concern. Therefore, we believe that the third carpometacarpal joint should be included in the total arthrodesis of the wrist and that the second metacarpal joint should be excluded unless there is evidence of post-traumatic osteoarthrosis at the articulation.

The results of the present study support the observations of Buck-Gramcko and Lohmann⁴ who found that the duration of disability leave from work was shortened considerably when arthrodesis was performed with use of a compression plate rather than with traditional bone-grafting techniques. These findings are also consistent with those of another study, which demonstrated little impairment of the function of the upper extremity after arthrodesis of the wrist³⁵.

The number of complications observed in our study was consistent with that reported by Clendenin and Green⁹. In fact, many of the complications represented coincidental problems resulting from the primary post-traumatic condition. The prevalence of pain in the distal radio-ulnar joint and of compression of the median nerve in the carpal tunnel after arthrodesis of the wrist suggests that these two particular entities warrant careful consideration during preoperative evaluation. Most of the arthrodeses of the wrists were performed after previous operations, many of which had been fraught with complications. Therefore, the likelihood that complications would develop from the arthrodesis increased, as it was performed as a salvage procedure. On the basis of the data in our series, it seems prudent for surgeons to inform patients of the potential for additional operations subsequent to the arthrodesis of the wrist.

References

Introduction | Materials and Methods | Results | Discussion | References

Abbott, L. C.; Saunders, J. B. D. M.; and |and |Bost, F. C.: Arthrodesis of the wrist with the use of grafts of cancellous bone. J. Bone and Joint Surg.,24: 883-898, Oct. 1942.24883 1942

Benkeddache, Y.; Gottesman, H.; and |and |Fourrier, P.: Multiple stapling for wrist arthrodesis in the nonrheumatoid patient. J. Hand Surg.,9A: 256-261, 1984.9A256 1984

Brittain, H. A.: Architectural Principles in Arthrodesis. Ed. 2, pp. 145-160. London, E. and S. Livingstone, 1952.

Buck-Gramcko, D., and Lohmann, H.: Compression arthrodesis of the wrist. In The Hand, edited by R. Tubiana. Vol. 2, pp. 723-729. Philadelphia, W. B. Saunders, 1985.

Campbell, C. J., and |and |Keokarn, T.: Total and subtotal arthrodesis of the wrist. Inlay technique. J. Bone and Joint Surg.,46-A: 1520-1533, Oct. 1964.46-A1520 1964

Carroll, D.: A quantitative test of upper extremity function. J. Chronic Dis.,18: 479-491, 1965.18479 1965 [PubMed][CrossRef]

Carroll, R. E., and |and |Dick, H. M.: Arthrodesis of the wrist for rheumatoid arthritis. J. Bone and Joint Surg.,53-A: 1365-1369, Oct. 1971.53-A1365 1971

Clayton, M. L.: Surgical treatment at the wrist in rheumatoid arthritis. A review of thirty-seven patients. J. Bone and Joint Surg.,47-A: 741-750, June 1965.47-A741 1965

Clendenin, M. B., and |and |Green, D. P.: Arthrodesis of the wrist—complications and their management. J. Hand Surg.,6: 253-257, 1981.6253 1981

Colonna, P. C.: A method for fusion of the wrist. Southern Med. J.,37: 195-199, 1944.37195 1944 [CrossRef]

Darrach, W.: Partial excision of lower shaft of ulna for deformity following Colles's fracture. Ann. Surg.,57: 764-765, 1913.57764 1913

Dick, H. M.: Wrist and intercarpal arthrodesis. In Operative Hand Surgery, pp. 127-139. Edited by D. P. Green. New York, Churchill Livingstone, 1982.

Haddad, R. J., Jr., and |and |Riordan, D. C.: Arthrodesis of the wrist. A surgical technique. J. Bone and Joint Surg.,49-A: 950-954, July 1967.49-A950 1967

Hazewinkel, J.: Arthrodesis of the radiocarpal joint. A surgical technique. J. Internat. Coll. Surg.,38: 137-140, 1962.38137 1962

Heim, U., and Pfeiffer, K. M.: Small Fragment Set Manual: Technique Recommended by the ASIF Group.(ASIF: Swiss Association for the Study of Internal Fixation). Ed. 2, pp. 53-54, 133-134, 143, 160-161. New York, Springer, 1982.

Ishida, O., and |and |Tsai, T.-M.: Complications and results of scapho-trapezio-trapezoid arthrodesis. Clin. Orthop.,287: 125-130, 1993.287125 1993 [PubMed]

Larsson, S.-E.: Compression arthrodesis of the wrist. A consecutive series of 23 cases. Clin. Orthop.,99: 146-153, 1974.99146 1974 [PubMed][CrossRef]

Manetta, P., and |and |Tavani, L.: Arthrodesis of the wrist with a compression plate. Italian J. Orthop. and Traumat.,1: 219-224, 1975.1219 1975

Mannerfelt, L., and |and |Malmsten, M.: Arthrodesis of the wrist in rheumatoid arthritis. A technique without external fixation. Scandinavian J. Plast. and Reconstr. Surg.,5: 124-130, 1971.5124 1971 [CrossRef]

Meuli, H. C.: Reconstructive surgery of the wrist joint. Hand,4: 88-90, 1972.488 1972 [PubMed][CrossRef]

Millender, L. H., and |and |Nalebuff, E. A.: Arthrodesis of the rheumatoid wrist. An evaluation of sixty patients and a description of a different surgical technique. J. Bone and Joint Surg.,55-A: 1026-1034, July 1973.55-A1026 1973

Minami, A.; Ogino, T.; and |and |Minami, M.: Limited wrist fusions. J. Hand Surg.,13A: 660-667, 1988.13A660 1988

Pipkin, G.: Medullary nailing of the wrist to the radius as a mechanical guide to ensure optimum position for wrist arthrodesis. Clin. Orthop.,57: 179-189, 1968.57179 1968 [PubMed]

Robinson, R. F., and |and |Kayfetz, D. O.: Arthrodesis of the wrist. Preliminary report of a new method. J. Bone and Joint Surg.,34-A: 64-70, Jan. 1952.34-A64 1952

Ross, W. T.: Arthrodesis of the wrist joint. An analysis of 48 operations. South African Med. J.,24: 755-757, 1950.24755 1950

Salenius, P.: Arthrodesis of the carpal joint. Acta Orthop. Scandinavica,37: 288-296, 1966.37288 1966 [CrossRef]

Skak, S. V.: Arthrodesis of the wrist by the method of Mannerfelt. A follow-up of 19 patients. Acta Orthop. Scandinavica,53: 557-559, 1982.53557 1982 [CrossRef]

Sovio, O. M., and |and |Gropper, P. T.: Wrist arthrodesis. Orthop. Trans.,9: 561-562, 1985.9561 1985

Straub, L. R., and |and |Ranawat, C. S.: The wrist in rheumatoid arthritis. Surgical treatment and results. J. Bone and Joint Surg.,51-A: 1-20, Jan. 1969.51-A1 1969

Taleisnik, J.: Subtotal arthrodeses of the wrist joint. Clin. Orthop.,187: 81-88, 1984.18781 1984 [PubMed]

Urbaniak, J. R.: Arthrodesis of the hand and wrist. In Surgery of the Musculoskeletal System, edited by C. McC. Evarts. Vol. 1, pp. 2:371-2:386. New York, Churchill Livingstone, 1983.

Watson, H. K.; Goodman, M. L.; and |and |Johnson, T. R.: Limited wrist arthrodesis. Part II: intercarpal and radiocarpal combinations. J. Hand Surg.,6: 223-233, 1981.6223 1981

Weiss, A. P., and |and |Hastings, H., II: Wrist arthrodesis for traumatic conditions: a study of plate and local bone graft application. J. Hand Surg.,20A: 50-56, 1995.20A50 1995

Weiss, A.-P. C.; Weiland, A. J.; Moore, J. R.; and |and |Wilgis, E. F. S.: Radial shortening for Kienböck disease. J. Bone and Joint Surg.,73-A: 384-391, March 1991.73-A384 1991

Weiss, A. C.; Wiedeman, G., Jr.; Quenzer, D.; Hanington, K. R.; Hastings, H. H., II; and |and |Strickland, J. W.: Upper extremity function after wrist arthrodesis. J. Hand Surg.,20A: 813-817, 1995.20A813 1995

Wright, C. S., and |and |McMurtry, R. Y.: AO arthrodesis in the hand. J. Hand Surg.,8: 932-935, 1983.8932 1983

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