Conversion of total wrist arthroplasty to arthrodesis with a custom-made PEG

Abstract

Conversion of a failed total wrist arthroplasty to arthrodesis can be difficult. A custom-made titanium alloy peg was constructed to enable arthrodesis with the original arthroplasty components in situ. Two out of three patients were especially challenging cases with little bone available. Bony union was achieved in 2 to 3 months. The peg simplified a difficult revision situation and gave good, predictable results at follow-up.

Keywords: arthrodesis; arthroplasty; revision; uncemented; wrist.

Fig. 1

The modular Motec wrist arthroplasty. Thick and short radial screw to the left and a thin and long capitate/third metacarpal screw on the right. A Morse taper is used for fixation of the articulation.

Fig. 2

The arthrodesis peg consists of identical cones on both sides with a crest in the middle of the peg. (a) 10 mm long midsection. (b) 12 mm long midsection.

Fig. 3

Preoperative radiographs of (a) patients 1, (b) 2, and (c) 3. In patients 1 and 2, metacarpal screws were used for fixation in the radius.

Fig. 4

Follow-up radiographs. (a) 0.5 year (patient 1). (b) 4.1 years (patient 2). (c) 4.3 years (patient 3) after surgery.

Fig. 5

Peg with angulation possibilities, the angle is adjusted after insertion and locked with the two small screws. (a) Fluoroscopic lateral view in cadaver. (b) In situ from the dorsal aspect.

Fig. 6

Intramedullary nail in the capitate and third metacarpal with locking screws. (a) Lateral fluoroscopic view in a cadaver, angulation according to the patient's preferences. (b) In situ from the dorsal aspect.