Journal of Orthopaedic Surgery 2010;18(1):87-91
Wrist arthrodesis for brachial plexus palsy
using an external ﬁxator and a cannulated
screw (Ioannina technique)
Marios D Vekris, Emilios E Pakos, Panayotis N Soucacos, Iosif Gavriilidis, Alexandros E Beris
Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine,
delayed fusion and slight wrist instability, because
the shorter screw was embedded in the cancellous
ABSTRACT bone and not self-tapped to the cortex. Fusion was
achieved after replacement with a longer screw.
Purpose. To present a new technique for wrist No patient developed a superﬁcial or deep wound
arthrodesis and review its treatment outcomes in 33 infection; 2 developed pin track infections. All patients
patients with brachial plexus palsy. were satisﬁed with the outcome and able to perform
Methods. 26 men and 7 women (mean age, 26 years) simple daily activities after one year.
with global brachial plexus palsy underwent wrist Conclusion. Our new technique for wrist arthrodesis
arthrodesis using an external ﬁxator and a cannulated is less invasive. Blood loss, the risk of postoperative
screw. All surgeries were performed under local infection, and adhesions at the extensors are
anaesthesia by a single senior surgeon. An external decreased.
ﬁxator was applied to the radius and the metacarpal
of the index ﬁnger. The articular surfaces of the radius, Key words: arthrodesis; bone screws; brachial plexus
scaphoid, lunate, and capitate were debrided, and a neuropathies; external ﬁxators; muscle weakness; wrist joint
cannulated screw inserted from the base of the radial
styloid to the carpo-metacarpal joint of the ring ﬁnger.
Cancellous allografts mixed with demineralised bone INTRODUCTION
matrix were added to the decorticated wrist bones.
The external ﬁxator was removed at week 8 and the Brachial plexus palsy can be caused at birth by a
wrist protected with a short-arm splint until solid difﬁcult delivery or by other trauma, and often affects
wrist fusion. young people. The treatment of choice involves
Results. All patients achieved wrist fusion after a aggressive early microsurgical reconstruction. After
mean of 14 (range, 12–16) weeks. Two patients had nerve reconstruction, upper-limb function can
Address correspondence and reprint requests to: Dr Marios D Vekris, 3rd Parodos Souliou 5, 45500, Eleousa, Ioannina, Greece.
88 MD Vekris et al. Journal of Orthopaedic Surgery
be improved by secondary operations, including side. The 3rd and 4th extensor compartments were
osteotomies, muscle transpositions, free functional elevated and pulled radially and ulnarly, respectively.
muscle transfers, and arthrodeses.1,2 The wrist joint was exposed by elevating a rectangular