Case report of total wrist arthrodesis using a novel technique with multiple headless screws fixation and transposed triquetrum as a local bone graft

Total wrist arthrodesis is a salvage procedure for the advanced arthritic or destructive condition. The traditional fixation method for total wrist arthrodesis is dorsal plating. We present a case with advanced rheumatoid wrist treated with total wrist arthrodesis using a novel fixation method with multiple headless screws and transposed triquetrum as a local bone graft.

A 57 year-old female patient with underlying rheumatoid arthritis suffered from rheumatoid arthritis of her right wrist and received total wrist arthrodesis with dorsal plating in 2020-12. Left wrist pain also developed due to the advanced rheumatoid arthritis. A period of conservative treatment was tried but failed. The image stuides including X-ray, CT and MRI showed diffuse cartilage destruction of both midcarpal and radiocarpal joint with fragmented and resorbed lunate. Open total wrist arthrodesis was performed in the following steps. The wrist was approached via a transverse capsulotomy. The fragmented lunate was excised and the articular surfaces of the midcarpal joint and radiocarpal joint were prepared to a bleeding subchondral surface. The triquetrum was excised in one-piece and was transposed to fill the space between lunate fossa and capitate. The radiocarpal joint and midcarpal joint were then fixed with three headless screw crossing the joint. The wrist was immobilized with a removable wrist brace for 2 months.

Partial union of the arthrodesis site was noted in the post-operative 3-month follow-up X-ray although mild radiolucent lines around the proximal portion of the screws in the distal radius were noted. The radiolucent lines did not progress and were stable; solid union of the arthrodesis was achieved 6 months after surgery. Her wrist was pain-free after the surgery and she was satisfied with the result.

Total wrist arthrodesis with multiple headless screw fixation is a possible alternative to dorsal plating and maybe could be performed arthroscopically in some selective cases.

Keywords: total wrist arthrodesis, headless screw