Locked Intramedullary Total Wrist Arthrodesis: A Report of Three Patients With Distal Screw Migration

Intramedullary (IM) fixation for the total wrist arthrodesis (TWA) is supposed to lower the hardware complication rate by eliminating soft tissue irritation. In this report, we present three patients with distal metacarpal screw migration requiring unplanned secondary surgery for screw removal in one patient while it was managed nonoperatively in the other two. All three patients had complete radiocarpal fusion by four months postop. There was no attempted third carpometacarpal (CMC) fusion in any of our patients. Screw migration was found between 1.5-3.5 months postop and remained stable until the final follow-up in the nonoperatively managed patients. One patient with screw removal continued to have mild tenderness over the third CMC, which was managed nonoperatively.