Spider Plate Fixation Device in Limited Wrist Arthrodesis, No Superior Improvement over Kirschner Wires and Herbert Screws
Evan D. Collins, MD and Jose Nolla, MD

This study examines the benefits of utilizing the "Spider Plate" fixation device in limited wrist arthrodesis, and assesses whether or not it indicates a trend towards higher fusion rates and improved range of motion in limited carpal fusions of the wrist.

Materials and Methods

  • Conducting a blinded study over a two-year period, five fellowship-trained hand surgeons saw 30 patients at an academic referral center in Houston.
  • Twenty-four men and 6 women (average age of 45) were treated with limited wrist arthrodesis using the three-dimensional, fully recessed and circumferential compression 8 and 6-hole Spider Plates - with 2.4 mm diameter stainless steel screws as the fixation device.
  • There were 13 Scaphoid Nonunion Advanced Collapse (SNAC) patients treated with scaphoid excision and 4-corner fusion and two treated with only 4-corner fusion. Twelve Scapholunate Advanced Collapse (SLAC) patients were treated with scaphoid excision and 4-corner fusion and two were treated with scapho-luno-capitate (SLC) fusions. One Kienböck's patient was treated with scaphocapitate (SC) fusion.
  • The articular surface of the bones to be fused was denuded of articular cartilage. The joints were packed with bone graft obtained from the distal radius, or iliac crest. The plate was secured to each bone and followed by capsule and skin closure.
  • Sutures were removed at approximately 10 to 14 days, and patients were immobilized a minimum of 4 weeks in a short arm cast.
  • Chart review noting epidemiology, etiology and clinical results was performed on all patients. Subjective and objective evaluations were reported.

Results

  • The 4-corner fusions at an average radiographic follow-up of 5.2 months indicated radiographic fusion in 92% of the triquetrohamate joints, 92% of the capitohamate joints and 92% of the lunatocapitate joints - though only 50% of the lunotriquetral joints.
  • Screws were proud in 30% of Regular Spider Plate patients. Breakage occurred in 7% - requiring revision surgery.
  • Subjective results revealed 56% of the patients reported good results, while 41% reported pain. And 3% was unreported.






Conclusion

  • Overall, the Spider Plate showed no significant improvement over K-wires, compression bone screws, or staples. Study patients experienced complications of screw breakage and nonunion - and achieved less range of motion than with other techniques at comparable milestones.
  • Based on these initial findings, the surgeons reassessed the way limited intercarpal fusions were performed and have not utilized the Spider Plate to the same extent they had prior to the study.