Arthrodesis of the spastic wrist.J Hand Surg Am. 1999 Sep; 24(5):944-52.JH
The clinical and radiographic results of 9 patients (11 wrists) who had wrist arthrodeses for severe spastic flexion contracture were evaluated. The spasticity was due to cerebral palsy, traumatic head injury, and cerebrovascular accident. All wrist deformities were aesthetically unappealing and the patients or their caretakers had difficulty with hygiene or function. The subjective evaluation included overall satisfaction, hand hygiene, wrist deformity, functional improvement, and willingness to have surgery again given the same preoperative circumstances. A standardized hand function questionnaire was used to determine functional improvement following surgery. The objective evaluation included clinical evidence of fusion, skin condition, wrist position, and radiographic assessment. The average age of the patients was 22 years at the time of surgery and the average follow-up period was 32 months. All patients were satisfied with the results of the surgery and hygiene improved in all cases. None had palmar skin maceration or breakdown. All patients or their caretakers rated the overall appearance or wrist and hand deformity as improved and all but one patient would agree to have the surgery over again given the same preoperative circumstances. According to a 17-task hand function questionnaire, 8 of 9 patients (10 wrists) reported improved function after surgery. Face washing, propelling a wheelchair, and picking up both large and small objects were among the most frequently improved functions. Radiographic fusion was present in all cases. The average position of wrist fusion was 15 degrees flexion and the average amount of wrist correction was 85 degrees. Improved appearance, hygiene, and a certain degree of upper extremity function, regardless of cognitive abilities, can be expected following arthrodesis for severe spastic wrist deformity.