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Wrist Fusion in Posttraumatic Brachial Plexus Palsy

Terzis, Julia K., M.D., Ph.D.; Barmpitsioti, Antonia, M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 2027-2039
doi: 10.1097/PRS.0b013e3181bcefe0
HAND/PERIPHERAL NERVE: ORIGINAL ARTICLES
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Background: Devastating brachial plexus injury with multiple root avulsions results in wrist instability, imbalance, and inability of patients to control the placement of their hand in space. In this study, results of wrist arthrodesis were analyzed in relation to factors such as age, severity score, and additional hand reanimation procedures. Indices of patient satisfaction were also measured using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.

Methods: Between January of 1978 and January of 2006, 97 patients with posttraumatic plexopathies underwent secondary procedures for hand reanimation. Sixty-one of these patients had wrist fusion. Arthrodesis was performed between the radius and third metacarpal using mainly a rigid plate; iliac bone graft was used in the majority of patients. Thirty-one patients underwent muscle transfers (45 free muscles) and 11 had tendon transfers in the wrist fusion group to enhance finger function. Patient self-assessment was carried out using the Terzis and Disabilities of the Arm, Shoulder and Hand questionnaires.

Results: All patients’ wrists fused. Patients with free-muscle transfer for finger flexion and extension achieved superior muscle grading compared with patients without wrist fusion, but this was not significant. A total of 35 patients (57.37 percent) answered the questionnaires; 97.14 percent were satisfied with wrist stability and 88.57 percent reported that the procedure enhanced the overall upper limb function. The Disabilities of the Arm, Shoulder and Hand score was 59.14 ± 12.9, which means moderate ability in daily activities.

Conclusions: Wrist fusion in patients with brachial plexus palsy is recommended as a complementary procedure, offering a stable, painless carpus, with improvement of overall upper limb function and appearance.

Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.

Received for publication March 18, 2009; accepted June 29, 2009.

Disclosure:Neither of the authors received financial support for this study.

Julia K. Terzis, M.D., Ph.D., Department of Surgery, Division of Reconstructive Surgery, Eastern Virginia Medical School, 700 Olney Road, LH 2055, Norfolk, Va. 23501, mrc@jkterzis.com

©2009American Society of Plastic Surgeons