Introduction and Aims: The purpose of this study was to investigate the effectiveness of a specifically designed titanium wrist fusion plate for use in wrist arthrodesis. The possibility of no or minimal casting post-operatively was considered and an early return to function was another proposed benefit.

Method: Ten consecutive patients with pathology requiring wrist arthrodeses were subjected to wrist fusion by means of a titanium wrist fusion plate. In all 10 cases, a similar technique was used securing the plate to the third metacarpal and the radius. In all cases, autologous bone graft was harvested from the patient’s iliac crest. Time to union, time of immobilisation and overall functional results were looked at. Patient satisfaction with the procedure was also documented.

Results: In all 10 patients, solid radiological union was documented between eight and 12 weeks. The pre-contoured plates produce a satisfactory and consistent position of fusion when correctly applied. Six of the 10 patients were managed with a light cast for six weeks post-operatively. The other four patients were treated with no immobilisation at all. There was no failure of fixation in this small series. One patient with a pre-existing transverse scar on the dorsum of the wrist, a small area of skin necrosis occurred. This healed by secondary intention over a four-week period.

Conclusion: The titanium arthrodesis plate provides a reliable good method for wrist fusion. Although the longitudinal scar is longer than necessary in some other techniques described, and the carpometacarpal joint is included in the fusion, the overall level of patient satisfaction is high.

Following up seven consecutive patients for a minimum of 3 years, we assessed the clinical outcome and level of patient satisfaction after distal ulnar head replacement.

In one patient the procedure was done because of a tumour. In the rest the pathology was predominantly OA and RA.

At follow-up, all patients had almost full pronation and supination. Grip strength was better than it was preoperatively, but generally not as good as in the non-pathological hand. In one patient instability was a problem, but overall patient satisfaction was high.

Although our study was of a small group and follow-up has been relatively short, early indications are that distal ulnar head replacement is a reliable and effective way of managing selected patients with problems that are otherwise difficult to treat.

Treating 10 consecutive patients requiring wrist arthrodesis, we assessed the effectiveness of a titanium plate specifically designed by Hill Hastings for wrist arthrodesis. It appeared to call for little or no postoperative casting and to promise an early return to functionality.

We secured the plate to the third metacarpal and the radius and used autologous bone graft taken from their iliac crest. Length of time immobilisation, time to union, overall functional results and patient satisfaction were recorded.

In all 10 patients clinical and radiological union occurred in 8 to 12 weeks. Four patients had no postoperative immobilisation and six had a Litecast. Correctly applied, the pre-contured plate produced a consistently satisfactory position of fusion. One patient had a small area of wound skin necrosis in a pre-existing transverse scar over the dorsum of the wrist, but this healed.

The carpometacarpal joint is included in this fusion, which requires a longer longitudinal incision than some other wrist fusion techniques. However, patient satisfaction was high.