Wrist arthrodesis has been used to alleviate pain and correct instability in joints that have been destroyed by numerous pathologic processes. Many different techniques have been used including wires, intramedullary nails, and staples. Rigid plate fixation has achieved excellent clinical results in the adult population. A similar fusion plate was designed to accommodate the smaller bones in children and adolescents.
The pediatric-sized wrist fusion plate (Synthes, USA) is constructed out of titanium and is 104 mm in total length, tapering from 8 mm in width proximally to 6 mm distally. The plate accommodates a total of eight screws. The proximal four screws are 2.7 mm and the distal four screws are 2.4 mm. The plate is prebent into 10 degrees of slight extension.
The first five patients treated with this plate are reported. The indication for surgery was paralysis (spinal cord injury) in three, and spasticity (cerebral palsy and traumatic brain injury) in two. Proximal row carpectomy was performed in the two patients with spasticity. Iliac crest bone graft was used in four of five patients. Union was achieved in all five patients at an average follow-up time of 2.2 years (range, 1-3 years). None of the patients or their parents complained of plate prominence. No patient required hardware removal. Improved limb stability was noted in all and enhanced use of the extremity in four.
Plate fixation for wrist arthrodesis leads to predictable union in the adult population. Application of this principle to children is appealing, although prominent hardware, pain, and extensor tendon adhesions are potential problems. The preliminary use of the pediatric-sized wrist fusion plate is encouraging in this small cohort of patients. This design facilitates the surgical procedure, reliably positions the wrist, and achieves union. However, rigid plate fixation is not applicable to children with open growth plates who still have considerable growth potential. In addition, not all practitioners (or patients) would feel comfortable with plate retention in the pediatric population, and this technique may then necessitate a second operation for hardware removal.
Journal of Pediatric Orthopaedics