Wrist arthrodesis in cerebral palsy.

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.