Four-corner fusion using a specialized circular locking plate

Abstract

Four-corner fusion associated to scaphoid excision is a standard procedure for advanced carpal collapse stage II and III. The purpose of this study is to evaluate the effectiveness of the four-corner technique using a specific designed locking plate of latest generation (Flowero, KLS-Martin) in the treatment of these degenerative clinical conditions. From October 2012 to December 2015, 13 patients, 11 males and 2 females, underwent to scaphoidectomy and four-corner arthrodesis using the Flowero (KLS-Martin) circular locking plate. The surgical technique were standardized. Through a dorsal approach, after the denervation of the posterior interosseous nerve, the scaphoid and the tip of the radial styloid were excised. The articular surfaces of the lunate, capitate, triquetrum and hamate were prepared, an autologous bone graft was inserted and the bones were always fixed by the same circular plate. The wrist has been immobilized for 20 days and then the rehabilitation started. Three patients were affected with a scapho-lunate advanced collapse (SLAC) and 10 with a scaphoid nonunion advanced collapse (SNAC). The mean age is 48 years. The mean follow-up is 22 months (range 6–44 months). All patients underwent a CT scan to study the real achievement of the fusion and a clinical evaluation, including wrist functional scoring, pain and personal satisfaction. Only 2 patients did not show a complete fusion at the CT scan evaluation. All patients are satisfied by the operation. They returned to their work and manual activities with mild limitation. Nowadays, they do not complain pain anymore, except the patients who did not obtain the bone fusion. The reduction of range of motion affects mostly the flexion. The grip strength is better than before the surgery. The four-corner arthrodesis with circular locking plate is a good and safe technique that allows a satisfactory recovery.