Shortening wrist arthrodesis using a Rush pin in adult spastic wrist: A series of 15 cases

In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal plate osteosynthesis. Ideally, fixation with smaller hardware volume farther from the tendons would limit postoperative tendon irritation and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults. A retrospective study included all patients with a central neurological impairment, undergoing SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months’ follow-up. Attainment of preoperative objectives was evaluated by Global Assessment of Response to Treatment (GART, ranging from −4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and any degenerative changes in the third metacarpophalangeal joint were assessed on X-ray. Fifteen patients were included, with a mean follow-up of 13 months (range, 6–29). In general, the preoperative objectives were attained: mean GART score was 2.7 (range, 1–4). Functional objectives were attained in 3 of the 11 patients followed up (27%). In all cases, the arthrodesis had healed at a mean 74 days (range, 39–102). Three had hardware removed after consolidation; 1 experienced discomfort at the head of the third metacarpal. Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications. IV, retrospective study without control group. L’arthrodèse raccourcissante du poignet (ARP) chez l’adulte spastique est indiquée en cas de flessum majeur fixé. La technique la plus utilisée actuellement est l’ostéosynthèse par plaque par voie dorsale. Une ostéosynthèse moins volumineuse à distance des tendons limiterait l’irritation tendineuse postopératoire et les taux de réintervention pour ablation du matériel. L’objectif de notre étude était d’évaluer les résultats de l’ARP par clou de Rush chez les patients spastiques adultes. Dans une étude rétrospective, ont été inclus les patients présentant une atteinte neurologique centrale, ayant bénéficié d’une ARP à l’aide d’un clou de Rush introduit par la tête du troisième métacarpien, avec un recul minimum de 6 mois. L’objectif préopératoire était relevé et sa satisfaction était évaluée par