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Wrist arthrodesis in cerebral palsy.
J Hand Surg Am. 2009 Sep; 34(7):1216-24.JH

Abstract

PURPOSE

Cerebral palsy patients with spastic wrist deformities can be treated with wrist arthrodesis to improve appearance, hygiene, and function. This study evaluates dorsal plating technique and need for bone grafting as measured by fusion rate, complications, and clinical outcomes.

METHODS

Thirty-four patients (41 wrists) with severe spastic wrist flexion deformities were treated by wrist arthrodesis using a dorsal plating technique. A comprehensive review of charts and radiographs was performed. Twenty-three patients were subjectively evaluated using the Disability Assessment Scale and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain, and overall satisfaction.

RESULTS

The union rate following dorsal plating was 98% (40/41 wrists). Eighteen patients developed plate irritation requiring hardware removal after union. Five major complications included 4 fractures (1 metacarpal and 3 radius) through screw holes and 1 nonunion. Patient outcome assessment showed that Disability Assessment Scale scores (10, worst-0, best) improved significantly (p = .01), from a preoperative mean of 9.6 to a postoperative mean of 5.5. Visual analog scale scores (0, much worse-10, much better) demonstrated substantial improvements in appearance (7.9), function (6.0), ease of daily care (7.0), and hygiene (6.2). Ninety-four percent of patients were satisfied, with an average satisfaction visual analog scale score of 8.3.

CONCLUSIONS

Wrist arthrodesis using a dorsal plating technique had a high union rate (98%) and a high rate of satisfaction (94%). Hardware complications were common, and consequently, we now routinely recommend hardware removal.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Authors+Show Affiliations

University of Minnesota, Department of Orthopaedic Surgery, Minneapolis, MN 55454, USA. vanhe003@umn.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19500917

Citation

Van Heest, Ann E., and David Strothman. "Wrist Arthrodesis in Cerebral Palsy." The Journal of Hand Surgery, vol. 34, no. 7, 2009, pp. 1216-24.
Van Heest AE, Strothman D. Wrist arthrodesis in cerebral palsy. J Hand Surg Am. 2009;34(7):1216-24.
Van Heest, A. E., & Strothman, D. (2009). Wrist arthrodesis in cerebral palsy. The Journal of Hand Surgery, 34(7), 1216-24. https://doi.org/10.1016/j.jhsa.2009.03.006
Van Heest AE, Strothman D. Wrist Arthrodesis in Cerebral Palsy. J Hand Surg Am. 2009;34(7):1216-24. PubMed PMID: 19500917.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Wrist arthrodesis in cerebral palsy. AU - Van Heest,Ann E, AU - Strothman,David, Y1 - 2009/06/04/ PY - 2008/04/21/received PY - 2009/03/03/revised PY - 2009/03/05/accepted PY - 2009/6/9/entrez PY - 2009/6/9/pubmed PY - 2010/1/16/medline SP - 1216 EP - 24 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 34 IS - 7 N2 - PURPOSE: Cerebral palsy patients with spastic wrist deformities can be treated with wrist arthrodesis to improve appearance, hygiene, and function. This study evaluates dorsal plating technique and need for bone grafting as measured by fusion rate, complications, and clinical outcomes. METHODS: Thirty-four patients (41 wrists) with severe spastic wrist flexion deformities were treated by wrist arthrodesis using a dorsal plating technique. A comprehensive review of charts and radiographs was performed. Twenty-three patients were subjectively evaluated using the Disability Assessment Scale and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain, and overall satisfaction. RESULTS: The union rate following dorsal plating was 98% (40/41 wrists). Eighteen patients developed plate irritation requiring hardware removal after union. Five major complications included 4 fractures (1 metacarpal and 3 radius) through screw holes and 1 nonunion. Patient outcome assessment showed that Disability Assessment Scale scores (10, worst-0, best) improved significantly (p = .01), from a preoperative mean of 9.6 to a postoperative mean of 5.5. Visual analog scale scores (0, much worse-10, much better) demonstrated substantial improvements in appearance (7.9), function (6.0), ease of daily care (7.0), and hygiene (6.2). Ninety-four percent of patients were satisfied, with an average satisfaction visual analog scale score of 8.3. CONCLUSIONS: Wrist arthrodesis using a dorsal plating technique had a high union rate (98%) and a high rate of satisfaction (94%). Hardware complications were common, and consequently, we now routinely recommend hardware removal. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/19500917/Wrist_arthrodesis_in_cerebral_palsy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(09)00223-8 DB - PRIME DP - Unbound Medicine ER -