Wrist, first carpometacarpal joint, and thumb interphalangeal joint arthrodesis in patients with brachial plexus injuries

Purpose: Wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis can be used in conjunction with other reconstructive measures to improve function and grasp in patients with complete brachial plexus injuries. This study evaluates wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis as measured by fusion rate, complications, and clinical outcomes. Methods: A retrospective chart review was performed for 24 skeletally mature patients with brachial plexus injuries treated with wrist arthrodesis by a dorsal plating technique, first carpometacarpal joint arthrodesis by staples, and thumb interphalangeal joint arthrodesis by a tension band wiring technique. Nineteen patients were subjectively evaluated using prearthrodesis and postarthrodesis Disabilities of the Shoulder, Arm, and Hand scores, visual analog pain scores, and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain, and overall satisfaction. Results: There was 100% union rate with 1 postarthrodesis complication. One patient required wrist fusion plate removal because of painful hardware. Subjective patient assessments showed a statistically significant (P <.001) improvement in Disabilities of the Shoulder, Arm, and Hand scores (from 51 to 28) and pain scores (from 5.3 to 3.2) before and after arthrodeses. The visual analog questionnaire results revealed improvements in appearance, function, daily cares, hygiene, pain, and satisfaction. Conclusions: Wrist arthrodesis, first carpometacarpal joint arthrodesis, and thumb interphalangeal joint arthrodesis had high union rates with minimal complications. Patients benefited from the improved function of their upper extremities and were satisfied with the surgery. The use of wrist, first carpometacarpal joint, and thumb interphalangeal joint arthrodeses in combination should be considered one of the reconstructive possibilities for patients with complete or nearly complete brachial plexus injuries. Type of study/level of evidence: Therapeutic IV.