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.

Conservative treatment of the ‘boxer’s fracture’ gives acceptable functional results but often leaves the patient with a residual deformity.

Using a prograde intramedullary K-wire, we treated 23 consecutive patients with a fractured neck of the fifth metacarpal. Volar angulation exceeded 40°. A 1.6-mm pre-bent K-wire was inserted via the base of the fifth metacarpal in each case. Time to regaining full function, time to union and final functional and radiological outcome were recorded.

All 23 patients went on to full clinical and radiological union within six weeks. In 18 patients, the reduction was anatomical with no residual angulation. In five the residual angulation ranged from 5° to 15°, with a mean of 8°. There was a transient sensory neuropraxia in two patients.

This minimally invasive technique is a simple, cost-effective and reliable method of treating a ‘boxer’s fracture’ and ensures a rapid return to full function with little or no residual deformity.

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.

Acromioclavicular (AC) joint dislocations and fractures of the distal clavicle present challenging problems for the treating surgeon. We treated eight patients using a hook-shaped plate fixed to the distal clavicle and ‘hooked’ under the posterior acromion.

In five patients the injury was a fractured distal clavicle and in three an AC joint dislocation. We analysed the time taken to achieve a functional capacity. The eventual functional result was indexed from the time of fracture union or complete stabilisation of the dislocations.

All five fractures went on to anatomical union. The three dislocations were all stabilised with no instability or sub-luxation. Two patients complained of impingement symptoms and decreased overhead functional capacity. After the implant was removed, both patients regained a full range of pain-free movement.

This is a small study with limited follow-up. However, the results suggest that this new implant provides an acceptable alternative in the management of distal clavicle fractures and AC joint dislocations. The complication of impingement can be treated by removal of the implant after union or stabilisation has been achieved.