Long-term Grip Strength and Complications After Total Wrist Fusion With and Without Inclusion of the Third Carpometacarpal Joint: A Systematic Review and Meta-analysis.

PURPOSE: Total wrist fusion (TWF) is a reliable surgical procedure for wrist arthritis. Options include: arthrodesis of the third carpometacarpal (CMC) joints (third CMC joint fusion); bridging the third CMC joint without fusion (third CMC joint bridging); or using a nonspanning plate (third CMC joint sparing). The review aimed to evaluate and compare these techniques regarding grip strength and complications.

METHODS: A systematic review searched MEDLINE, Embase, and Scopus databases. Observational studies and randomized controlled trials investigating dorsal plate TWF were included. Meta-analysis was conducted using Stata (version 18). Grip strength was defined as long-term (12+ months) postoperative kilogram force in the operative hand expressed as percentage of contralateral hand and analyzed using a random-effects meta-analysis. The Freeman-Tukey transformation was applied to stabilize the estimates of variance, and complications were analyzed using a random-effects meta-analysis of single proportions. Subgroup analysis was performed for early/intermediate (0-30 months) and delayed (30+ months) follow up.

RESULTS: Sixteen studies were identified, including 786 wrists. Mean follow up was 5.4 years. Only six studies reported grip strength as an outcome measure. To permit statistical analysis, the third CMC joint fusion and third CMC joint bridging groups were combined (termed third CMC joint spanning) and compared against the third CMC joint sparing group, revealing no significant difference in mean grip strength (74% vs 64%). Between 0 and 30 months, there was no statistically significant difference in complication rate (third CMC joint fusion = 24%, third CMC joint bridging = 16%, and third CMC joint sparing = 14%). Beyond 30 months, there was a higher rate of complications in the third CMC joint bridging group than in the third CMC joint fusion group (50% vs 20%). Longer-term follow-up data were not available in the third CMC joint sparing group. There was no significant difference in the union rates between groups (96% to 97%).

CONCLUSIONS: There is a higher rate of complications with a third CMC joint bridging technique than the third CMC joint fusion technique. Early outcomes of third CMC joint sparing techniques appear equivalent but longer-term data are still required.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.