【Abstract】Objective To evaluate the clinical efficacy of carpal fusion plate internal fixation. Methods From July 2000 to December 2004, 25 cases of traumatic carpal arthritis were treated with carpal fusion plate internal fixation, of which 21 cases were followed up at 20 months after the operation.Follow-up examinations included the degree of pain in the carpal joints, mobility of the finger joints, grip strength, and X-rays.The Buck-Gramcko/Lohmannn scale was used to evaluate the overall function of the carpal joints, and the DASH questionnaire evaluated the effect of wrist fusion on patients’ daily activities and quality of life. The pain value of the wrist was 1.5, 12 metacarpophalangeal joints and 10 interphalangeal joints of the thumb showed slight dorsiflexion dysfunction, and the grip strength of the wrist was 30 K (38 K on the healthy side). x-ray showed that all the carpal joints were fused. the value of the Buck-Gramcko/Lohmannn Score was 8.7, of which 5 cases were excellent, 10 cases were good, and 6 cases were moderate. the value of the DASH Score was 32, and the DASH questionnaire indicated that the wrist joints were fused with the wrist joints. The results showed partial limitation of daily activities after wrist fusion. Conclusion The success rate of internal fixation of carpal fusion plate was high, and the pain of carpal joint was significantly reduced, but some of the functions of the carpal joint were lost after the operation. 【Keywords】carpal; carpal fusion; internal fixation; steel plate; clinical efficacy Carpal fusion is considered to be the ultimate means of treating carpal injuries, with a variety of fusion methods. 25 cases of carpal fusion with internal fixation of steel plate were performed in our hospital from July 2000 to December 2004, of which 21 were followed up. In addition to assessing the hand strength, pain level and mobility during the follow up, patients’ daily activities and quality of life were also evaluated. In addition to the evaluation of hand strength, pain and activity level, the patients were also evaluated on their daily activities and quality of life, and the results of the follow-up were reported as follows: Data and Methods 1. General treatment: 21 cases were followed up in this group, 15 cases were male and 6 cases were female; their ages ranged from 25 to 47 years old, and the average age was 37 years old. 8 cases on the left side, 13 cases on the right side, all patients were right-handed. All were 14 cases of C3 type fracture of the distal radius (AO typing) and 7 cases of arthritis due to old navicular fracture, of which 1 case was combined with ulnar fracture. Preoperatively, 5 patients had undergone fracture osteotomy and reduction and 1 ulna osteotomy and reduction and internal fixation. 2, Surgical method: after brachial plexus or general anesthesia, a balloon tourniquet was used. The back of the wrist was incised in s-shape, layer by layer to reveal the extensor tendon support band, the third extensor tendon sheath was incised sharply, and the fourth extensor tendon sheath was freed through the third extensor tendon sheath along the surface of the carpal joint capsule, and the bunion extensor tendon was pulled toward the radial side, and the common extensor tendon was pulled toward the ulnar side, the fourth extensor tendon sheath was found to search for the dorsal nerve of the interosseous at its base, and the 2M long nerve was resected, and the ulnar radial interosseous membrane was incised in longitudinal shape by 3-4 cm to search for the palmar nerve of interosseous, and the 2M interosseous palmar nerve was resected. The interosseous metacarpal nerve was resected for 2M lengths. The dorsal carpal joint capsule was incised longitudinally, the periosteum of the third metacarpal, carpal bones, and the dorsal surface of the radius was peeled sharply, the Lister’s node was chiseled off with a bone chisel, and the cartilaginous surfaces of the adjacent surfaces of the radius, navicular, lunate, capitate, and the large and small polydistal bones were removed with a bone biter. Iliac cancellous bone was implanted in the radial wrist and midcarpal gap, Stryker’s straight steel plate was bent 15º, the third metacarpal, capitellum, and radius were fixed within the plate, and the gap between the plate and the wrist was then filled with iliac cancellous bone. Intraoperative C-arm X-ray machine was used to observe the position of carpal fusion as well as the position of the plate screws. Carefully observe whether the ulna is too long and whether it interferes with the anterior and posterior rotation of the wrist, and resect the ulna head if necessary. The wound was flushed, and the plate was covered with surrounding soft tissues as much as possible. The joint capsule and the tendon sheath of the fourth extensor muscle were closed with 5/0 absorbable sutures. A drainage tube was placed in the trauma, and the skin was sutured. The forearm was externally immobilized with a plaster cast for three weeks. 3. Follow-up method: Clinical examination included surgical complications, wrist scars, and hand sensation. The postoperative use of the affected hand was obtained by asking the patients and was divided into four levels: normal hand function; only slight dysfunction of hand function; dysfunction of hand function; and severe dysfunction of hand function. Objective hand function evaluation indexes included metacarpophalangeal joint mobility, hand grip strength, and wrist joint pain level. Wrist pain level was assessed by visual analogue scales, VASw, with a pain value of 0 indicating no pain and a pain value of 10 indicating intolerable severe pain. Grip strength of both hands was measured with Jamar grip strength device, three measurements were taken on each side and the average value was taken. Overall function after wrist fusion was evaluated using the Buck-Gramcko/Lohmannn scale. The DASH questionnaire was used for subjective functional evaluation after wrist fusion. X-ray examination: each affected wrist joint was examined by orthopantomogram at the follow-up visit to observe the healing of the wrist joint and the position of the plate screws. Statistical analysis: X±Sx was used for all data in this group. Results Twenty-one patients were followed up for 6-46 months, with an average of 20 months. Postoperatively, one case had blood accumulation in the wound, and the wound healed in one stage after removing part of the suture for drainage; one case had red and swollen skin in the wound, which was cured after applying antibiotics; another case had necrotic skin edges, which was cured by changing the medication. one case had blood accumulation in the iliac bone part at the place of taking the cancellous bone after surgery, and the wound healed after removing part of the suture for implantation of drainage. At the time of follow-up, 4 patients complained of wound discomfort and scarring, which affected aesthetics. All patients had normal finger sensation at the time of follow-up. 8 patients underwent reoperation to remove the plate. Subjective evaluation of function: The subjective evaluation of function of patients at the time of follow-up showed that 4 patients had completely normal function, 12 patients had limitation of wrist joint in some specific activities, and 5 patients had dysfunction. Joint mobility: 12 patients had slight dorsiflexion dysfunction of the metacarpophalangeal joints, most of which occurred in the thumb, digit and middle finger, and none of them had all metacarpophalangeal joints with limited mobility; 10 patients had slight active dorsiflexion dysfunction of the interphalangeal joints of the thumb; and 4 patients had forearm rotational dysfunction, with pain in the ulnar side of the ulnar-radial joint or the wrist joint when rotating. The pain level: the pain value was 4.3(2-7) after weight bearing before operation, and all patients complained that the pain level of the wrist joint was significantly reduced compared with the pain level before operation at the follow-up visit, the pain level was 1.5(0-3) after operation, and the value of the pain value was 2.0(0-5) after weight bearing. 12 out of the 21 patients had no pain at all, 5 had pain in their wrist joints after heavy labor, which could be tolerated, and 4 had pain in their daily life or when rotating the forearm, which affected their work. Pain occurred when rotating, affecting work. Grip strength: preoperative grip strength was 17(5-31) kg; at follow-up, grip strength was 30(17-42) kg, and the healthy side was 38 kg. 15 patients had a grip strength of 75% or more of the contralateral side; 5 patients had a grip strength of 50%-75% of the contralateral side; and 1 patient had a grip strength of less than 50%. Buck-Gramcko/Lohmannn score: Buck-Gramcko/Lohmannn score value was 8.7, excellent in 5 cases, good in 10 cases and moderate in 6 cases. DASH questionnaire: the DASH questionnaire value was 32, indicating that the fusion of the wrist joint has a greater impact on the function of the affected limb, mainly in the following aspects: 1, in the need for flexibility in the use of the wrist joint in daily life are limited, such as flexibility in the use of the arm of the amateur activities (Article 19), the use of the arm of the strength or impact of activities (Article 18), as well as unscrewing the lid of a glass bottle (Article 1) and other activities; 2, to heavy There was a significant effect on heavy housework (Article 7) and garden and yard hygiene (Article 8), which required greater strength; 3. Postoperative discomfort: 4 patients complained of wrist pain (Article 25), and 4 patients complained of numbness and pinprick pain in the wrist and sleep disruption (Articles 26 and 29). X-ray examination: all 21 carpal joints were fused and none of the cases showed breakage of plates and screws. DISCUSSION Carpal fusion is considered to be the last resort in the treatment of traumatic carpal arthritis with the aim of relieving carpal pain. There are various methods and fixation materials for wrist fusion. In recent years, plate internal fixation has been increasingly used in wrist fusion [2,3,5-7], which has the advantages of good plate compression, secure fixation of the wrist joint, early mobilization of adjacent joints, and avoidance of joint stiffness. Follow-up results of carpal fusion plate internal fixation vary widely. Zachary and Stern[5] reported 73 patients with AO/AISF plate fixation of the wrist, of which a total of 50 patients had a total of 82 complications.Houshian and Schroder[3] reported a postoperative complication rate of 28%.The postoperative complications included wound blood accumulation, wound infection, irritation of the extensor tendon by the plate and tendon rupture, ulnar nerve deep branch injury and carpal tunnel syndrome. injury and carpal tunnel syndrome. We found that most of the early postoperative complications were blood accumulation in the wound and infection, which were cured after appropriate treatment, while in the late stage, adhesion of the extensor tendon caused by the steel plate affected active dorsiflexion of the metacarpophalangeal joint. Some scholars [7] reported that the incidence rate of carpal tunnel syndrome after wrist fusion was as high as 25%, which was caused by the iliac bone implanted in the wrist joint compressing the metacarpophalangeal joint capsule and causing nerve compression, but there was no similar finding in our follow-up. We found that some patients’ metacarpophalangeal joint and interphalangeal joint movements were slightly affected after wrist fusion. There were 12 cases of active dorsiflexion dysfunction of the metacarpophalangeal joint after wrist fusion in our group, and this dysfunction was manifested in the obvious restriction of the radial metacarpophalangeal joint, but the restriction of the metacarpophalangeal joints of the ring and little finger was extremely rare, and the main reason for this was related to the fact that the steel plate we used in the operation was wider, and it was very difficult to cover the steel plate completely with soft tissues during the operation, which resulted in the steel plate coming into direct contact with the radial side of the extensor tendon and caused adhesion. The limited dorsal extension function of the thumb interphalangeal joint was related to the loss of the fulcrum of the extensor digitorum longus tendon by resection of the Lister’s node. We found that more than half of the patients (nearly 60%) were pain-free after wrist fusion, but more than 40 patients had wrist pain, and the pain was mostly on the ulnar side.The results of the studies by Sauerbier et al.[8] and Kalb et al.[9] also found that a small number of patients still had varying degrees of pain after wrist fusion. We analyzed the reasons for this may be the following: the patients not only had preoperative injuries to the radial wrist and midcarpal joint, but also may be accompanied by injuries to the inferior ulnar radial joint and the TFCC, and the injuries to the inferior ulnar radial joint and the TFCC were not handled during the wrist fusion surgery; another reason is that the wrist fusion occludes a number of articular cartilage surfaces, and the plate compression fixation will result in the ulna being overly long in relation to the radius, which will cause the ulna impingement syndrome after surgery, which will lead to the postoperative ulna impingement syndrome. syndrome, which triggers pain on the ulnar side of the wrist and forearm rotational dysfunction. Therefore, we believe that the wrist should be carefully examined preoperatively, especially in patients who present with pain on the ulnar side of the wrist, to prevent underdiagnosis of inferior ulnar-radial joint injury or TFCC injury. In addition, fluoroscopy with a C-arm X-ray machine should be applied during the fusion operation, and the ulnar tuberosity can be removed if the ulna is found to be too long on fluoroscopy, so as to avoid pain caused by ulnar impingement in the postoperative period. The Buck-Gramcko/Lohmmannn score after wrist fusion was 8.7, indicating that hand function was less affected after wrist fusion. However, we used the DASH questionnaire to further evaluate the impact of upper extremity function after wrist fusion, and the score was 32, which indicated that wrist fusion had a greater impact on daily life, and the loss of activity was mainly in the activities that required flexible use of the wrist as well as heavy labor, etc. The impact of heavy labor on some of the patients after wrist fusion may be related to the fact that the wrist strength could not be fully recovered, and some patients still had a loss of activity after wrist fusion. The influence of heavy labor on some patients after wrist fusion may be related to the fact that wrist strength cannot be fully recovered and some patients still have pain in the wrist joint after surgery, therefore, the surgical conversation should be clearly explained to the patients before wrist fusion surgery. CONCLUSION: The healing rate of carpal fusion with internal fixation of the wrist plate was high, the strength was well restored, and the pain was reduced in most of the patients. Some patients showed limited dorsiflexion of the metacarpophalangeal joint and thumb interphalangeal joint. In addition, patients’ daily life function will be affected after wrist fusion.