Corner Fusion Research Articles

Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis.

Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.

Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis

Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.

Proximal Row Carpectomy Versus 4-Corner Fusion: Regional Differences, Incidence, and Conversion to Fusion

Proximal Row Carpectomy Versus 4-Corner Fusion: Regional Differences, Incidence, and Conversion to Fusion

MFC Bone Graft for Scaphoid Nonunion, Osteonecrosis, and Failed Prior Surgery: Three Strikes But Not Necessarily Out: Commentary on an article by Nicholas Pulos, MD, et al.: "Free Vascularized Medial Femoral Condyle Bone Graft After Failed Scaphoid Nonunion Surgery".

Commentary Patients with a nonunion of the scaphoid with a proximal fracture line, osteonecrosis of the proximal pole, and a previously unsuccessful attempt at achieving surgical union present the orthopaedic surgeon with a difficult clinical decision. Some surgeons might advocate nonoperative treatment, with the expectation that a salvage procedure (scaphoid excision and 4-corner fusion, proximal row carpectomy, total wrist arthrodesis, or total wrist arthroplasty) might eventually be required to relieve pain and maintain motion. Others might recommend repeat open reduction and internal fixation using either vascularized or nonvascularized local bone, whereas those who are experienced with microsurgical techniques might attempt, on the basis of the data presented in this article, a vascularized medial femoral condyle (MFC) bone graft in order to achieve union and restore vascularity (and therefore mitigate against eventual collapse) of the proximal pole. The authors give us an honest appraisal and have made an important iterative contribution to the care of young patients with this challenging clinical problem. They acknowledged an almost 20% rate of additional surgery (apart from scheduled surgery for the removal of Kirschner wires) and also reported a 1-in-6 rate of persistent nonunion. Even though these results are a reason for reflection and discussion, this surgical procedure is an attempt to restore preinjury anatomy, which is, in my opinion, a worthy goal for these young, physically active patients. Whether the main issue is carpal collapse and humpback deformity in an SNAC (scaphoid nonunion advanced collapse) wrist following scaphoid fracture with proximal pole osteonecrosis (and an initial attempt at achieving surgical union), or pain and tenderness over the proximal pole due to fragmentation and collapse as well as the development of osteoarthritis between the distal scaphoid pole and the radial styloid, remains open to discussion. Also, this article did not address specifically whether the goal of restoration of scaphoid length by means of an MFC graft is directly related to the restoration of carpal alignment. It would seem so; however, this point is really only academic since proximal pole fractures and nonunions do not routinely lead to arthrosis between the proximal pole of the scaphoid and the distal radial articular surface as is seen in chronic SLAC (scapholunate advanced collapse) wrists. Although 1 patient had a subsequent radial styloid excision, the distal pole was not excised, presumably because of the condition of either the proximal pole or the scapholunate ligament, or both. Several caveats outlined in the article bear repetition. First, patients frequently lost wrist motion following this procedure, and this was manifested by several patients’ inability to return to push-up exercises. This is not an unimportant point, especially in patients with specific functional requirements related to their employment. Second, there were some sports-related difficulties as well as persistent discomfort that compromised the outcomes. My mention of this is not meant to denigrate the procedure or the results, but rather to encourage the surgeon to set realistic expectations—i.e., of results that are either similar to or slightly better than those achievable with salvage procedures in terms of pain relief, motion, and strength with (hopefully) longer-term durability. The cases presented in this article are seen infrequently, and the patients often expect a full return to sports and vocational activities. Preoperative counseling and the setting of achievable goals are to be stressed. The surgical results in this retrospective study suggest that, in the infrequent situation where a young patient presents with “3 strikes” (nonunion, osteonecrosis, and prior unsuccessful surgery), he/she might not necessarily be “out.”

Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis.

Background: Current treatment options for persistent scaphoid nonunion are limited to salvage procedures such as proximal row carpectomy (PRC) or 4-corner fusion (4CF). Several small studies have demonstrated that distal scaphoid excision may provide a simpler alternative with faster recovery. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for symptomatic scaphoid nonunion. Methods: The MEDLINE and PubMed databases were searched for the use of distal scaphoid excision in scaphoid nonunions. Studies included reported on either the functional or patient-centered outcomes following distal scaphoid excision for symptomatic scaphoid nonunion. Results: Six articles described the outcomes of 70 patients with an average of 11.7 patients per study. Functional outcomes including flexion-extension arc, radial-ulnar deviation, and grip strength improved by an average of 98.95%, 58.96%, and 131.08%, respectively. Patient-derived outcomes included the Modified Mayo Wrist Score, which improved by 92.6%, and the Disabilities of the Arm, Shoulder and Hand, which improved by 137.17%. An average of 68.75% of patients experience complete relief of pain with 20.83% of patients experiencing pain with strenuous activity. The average postoperative visual analog scale (0-10) was 0.71. On average, 93.33% of patients returned to work with an average time of return being 6.89 weeks. Complete satisfaction was reported by 87.80% of patients. Complications included progression into 4CF or PRC and newly developed midcarpal arthritis. Conclusions: Given favorable outcomes, our analysis suggests that distal scaphoid excision may be a favorable, low-risk treatment for scaphoid nonunion without eliminating more extensive options such as 4CF and wrist arthrodesis.

3D analysis of Osteosyntheses material using semi-automated CT segmentation: a case series of a 4 corner fusion plate

BackroundScaphoidectomy and midcarpal fusion can be performed using traditional fixation methods like K-wires, staples, screws or different dorsal (non)locking arthrodesis systems. The aim of this study is to test the Aptus four corner locking plate and to compare the clinical findings to the data revealed by CT scans and semi-automated segmentation.MethodsThis is a retrospective review of eleven patients suffering from scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist, who received a four corner fusion between August 2011 and July 2014. The clinical evaluation consisted of measuring the range of motion (ROM), strength and pain on a visual analogue scale (VAS). Additionally, the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Wrist Score were assessed. A computerized tomography (CT) of the wrist was obtained six weeks postoperatively. After semi-automated segmentation of the CT scans, the models were post processed and surveyed.ResultsDuring the six-month follow-up mean range of motion (ROM) of the operated wrist was 60°, consisting of 30° extension and 30° flexion. While pain levels decreased significantly, 54% of grip strength and 89% of pinch strength were preserved compared to the contralateral healthy wrist. Union could be detected in all CT scans of the wrist. While X-ray pictures obtained postoperatively revealed no pathology, two user related technical complications were found through the 3D analysis, which correlated to the clinical outcome.ConclusionDue to semi-automated segmentation and 3D analysis it has been proved that the plate design can keep up to the manufacturers’ promises. Over all, this case series confirmed that the plate can compete with the coexisting techniques concerning clinical outcome, union and complication rate.

Scaphoid Excision and Four Corner Fusion Using Anti-Grade Headless Compression Screws in the Management of Stage I and II SNAC Wrists

Introduction: Scaphoid Nonunion Advanced Collapse (SNAC) is a common cause of traumatic wrist degeneration. Scaphoid excision and Four-Corner Fusion (4-CF) has been shown to be an effective treatment option to relieve pain and in the same time preserve a good functional range of wrist motion.

Comparative Evaluation of Surgical Procedures with Clinical Equipoise: the Unique Perspective of Our Hand Therapy Colleagues.

There are several accepted surgical treatment options available for carpal tunnel syndrome, thumb carpometacarpal joint (CMC), osteoarthritis (OA), and wrist degenerative joint disease. We sought to obtain the views and preferences from a cohort of certified hand therapists (CHT) and hypothesized that this source may identify differences in procedures that are otherwise widely believed to have clinical equipoise. Five hundred twelve CHTs were surveyed regarding their experience, volume, and referral base along with their subjective assessments and preferences regarding open versus endoscopic carpal tunnel release (CTR), various surgical procedures for CMC OA, and proximal row carpectomy (PRC) versus 4-corner fusion (4-CF). The average CHT surveyed had 15.2years experience and had a referral base of 7.7 different hand surgeons. Twenty-seven percent of respondents perceived superior pain control and incisional tenderness following open CTR compared to that of endoscopic CTR. However, 68% of CHTs would elect to undergo an open CTR themselves. There was no clear consensus for the optimal reconstructive technique for thumb CMC OA. As compared to that of 4-CF, PRC was thought to result in superior pain control (34 versus 22%), motion (43 versus 18%), and earlier discharge from therapy (32 versus 19%); however, 53% of respondents would prefer a 4-CF for themselves. Hand therapists are intimately involved in the care of surgical patients and provide an educated and unique source for evaluating postoperative outcomes.

Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws.

Four-corner fusion has been shown to be a reliable option of treatment of wrist arthritis, but there is no consensus about which implant and surgical procedure should be used in the arthrodesis. The present study aimed to describe a surgical technique using 2 crossed screws as implants, inserted in a retrograde manner, and to demonstrate preliminary results of the use of the technique. A retrospective study was conducted using medical records and imaging tests (radiographs and computed tomography) of all 15 patients who underwent a standardized 4-corner fusion technique, between December 2011 and July 2015, in the Department of Hand Surgery of Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, Brazil. We collected data on the following variables: fusion rate, time to fusion, and percentage of patients who had any complications or needed another surgical procedure on the same wrist. All but one patient achieved fusion of arthrodesis. The average time to union was 5.54 months (SD = 3.84). Only the patient who developed nonunion of the 4-corner fusion required another surgery on the same wrist. The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.

Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist.

Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function. A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification. Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.

Decoupling the Wrist: A Cadaveric Experiment Examining Wrist Kinematics Following Midcarpal Fusion and Scaphoid Excision.

At the wrist, kinematic coupling (the relationship between flexion-extension and radial-ulnar deviation) facilitates function. Although the midcarpal joint is critical for kinematic coupling, many surgeries, such as 4-corner fusion (4CF) and scaphoidexcision 4-corner fusion (SE4CF), modify the midcarpal joint. This study examines how 4CF and SE4CF influence kinematic coupling by quantifying wrist axes of rotation. Wrist axes of rotation were quantified in 8 cadaveric specimens using an optimization algorithm, which fit a 2-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for 3 conditions (nonimpaired, 4CF, SE4CF). The calculated axes of rotation were compared using spherical statistics. The angle between the axes of rotation was used to assess coupling, as the nonimpaired wrist has skew axes (ie, angle between axes approximately 60°). Following 4CF and SE4CF, the axes are closer to orthogonal than those of the nonimpaired wrist. The mean angle (±95% confidence interval) between the axes was 92.6° ± 25.2° and 99.8° ± 22.0° for 4CF and SE4CF, respectively. The axes of rotation defined in this study can be used to define joint models, which will facilitate more accurate computational and experimental studies of these procedures.

Internal headless compression screw method for 4-corner fusion

Midcarpal fusion and scaphoidectomy, also referred to as 4 corner fusion, is a common treatment for post-traumatic wrist arthritis, either scapholunate advanced collapse or scaphoid nonunion advanced collapse. Historically fixation for the fusion mass was performed with Kirschner wires. Bone graft was sometimes taken from the discarded scaphoid. More recently, articles have focused on the method of fixation and its potential role in causing high nonunion rates or specific complications. This article offers readers a reliable technique for midcarpal fusion designed to minimize both nonunion and hardware related complications.

Three-Corner Fusion for Management of SNAC and SLAC Wrists

Objective: Presenting the results of fusion of the lunate bone with capitate and hamate bones plus excision of scaphoid and triquetrum in management of scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists, looking in particular at the resulted range of wrist motion. Hypothesis: Four corners fusion is considered the golden standard treatment of SNAC and SLAC wrists in the last decade. It is designed to result in relieving pain while maintaining a reasonable hand grip power and preserving some wrist mobility. Yet, many of the candidates wished to have a better arc of wrist movements. Materials and Methods: In a longitudinal study, 3 corner fusion procedure has been performed in 18 patients (12 had SNAC wrists and 6 had SLAC arthritis). Whereas, fusion between lunate, capitates, and hamate was performed together with excision of both of scaphoid and triquetral bones. Also excision of 3 to 4 mm of the radial styloid was carried out for all cases. Results: To date, all cases that were operated with this procedure eventually go into union in a period between 8 to 10 weeks. After an average followed-up period of 19 months (range, 13 to 40 months), the mean of flexion-extension arc of motion of their wrists decreased from 67% (preoperatively) to 62% (postoperatively) compared with the opposite side (range, 55% to 74%). The mean postoperative grip strength increased from 52% to 78% of the opposite side (range, 62% to 100%). None of the patients needed any further surgery and 75% were satisfied and 25% were pleased with the results. Conclusions: Results of 3 corner fusion are promising. The resulted range of wrist motion is relatively better than that obtained with 4 corner fusions, while grip strength and other clinical parameters are yet comparable.

Therapeutic Results of Nonunion of the Scaphoid Including Intractable Cases

Purpose: The nonunion of the scaphoid is caused by various mistreatment of the scaphoid fracture, including long-term untreated or inadequately treated cases. We report our findings and discussions on postoperative outcomes and selection of surgical procedures in 47 cases including 13 cases of refractory scaphoid nonunion that required multiple operations. Materials and Methods: Those 47 cases included 44 males and 3 females with an age range of 15 to 65 at the time of operation (mean age: 27.8). Focal curettage and bone graft for the nonunion site were applied in 40 cases excluding 7 with scaphoid nonunion advanced collapse (SNAC) wrist. As the methods of bone graft, Russe procedure was applied in 4 cases and Herbert procedure was applied in the other 36 cases. As the internal fracture fixation materials, K-wires were used in 6 cases, Herbert screw in 8 cases, Bold screw in 5 cases, Whipple screw in 3 cases, and Acutrak mini screw in 18 cases. Meanwhile, the proximal part of the scaphoid was resected with tendon ball graft, 4-corner fusion, or modified Graner procedure was applied in the 7 cases with SNAC wrist. Postoperative follow-up periods were 2 to 10 years (mean: 4 years 7 months). Results: Bone union was observed in 28 out of 40 cases. The remaining 12 cases included the following: 5 cases which went untreated for at least 15 years, 3 with the application of Herbert-Whipple screw, 2 with the application of Bold screw, 1 with the inadequate insertion of Acutrak mini screw, and 1 with repeat nonunion caused by broken Acutrak screws. Revision surgery was conducted for the all cases: 1 with Russe procedure, 1 with Herbert procedure, and other 10 with vascularized bone graft procedure (2 with Zaidemberg procedure and 8 with the second metacarpal bone graft). As a result, bone union was observed in 10 cases. As the final treatment outcome, the ratio of grip strength of an operated hand to that of nonaffected hand was 50% to 114% (mean: 89%) and flexion-extension arc was 60° to 180° (mean: 121°). Conclusions: We had a satisfactory outcome for our treatment of the scaphoid nonunion. However, it should be noted that pedicle vascularized bone graft procedure needed to be applied to long-term untreated or repeat nonunion cases.

Free Medial Femoral Condyle Flap for Reconstruction of Scaphoid Pseudarthrosis

Objective/Hypothesis: Nonunions of scaphoid are routinely treated by reconstruction with interposition of cancellous bone grafts from the iliac crest or distal radius. In unfavorable situations as persistent pseudarthrosis following surgical reconstruction or avascular proximal pole, vascularized bone grafts are preferred. Free vascularized bone grafts from the medial femoral condyle were introduced as an additional tool for reconstruction and showed promising results. Material and Methods: In this study, 71 scaphoid nonunions or pseudarthrosis were followed after reconstruction with vascularized bone graft form the medial femur. In 15 cases, an osteocartilaginous graft was used to replace the proximal pole. After a minimum follow-up of 6 months (64 patients), following data were evaluated: consolidation, complications, donor site morbiditiy, pain in rest and stress, range of motion, grip strength, and Krimmer score. Results: Consolidation rate was 88%, in 19.6 % minor complications occurred. Range of motion did not change significantly, 89% grip strength of opposite site could be regained. Pain (VAS) in rest was reduced by 73%, in stress by 51%. Donor site morbiditiy is tolerable: 14.5% had mild symptoms after 3 months, reducing to less than 2% after 6 months. Krimmer Score resulted in very good and good results in 60% of the cases. Conclusion: Reconstruction of scaphoid pseudarthrosis with the free medial femoral condyle bone graft is an adequate technique to reach high consolidation rates in unfavorable situations. Postoperative function improves in terms of grip strength and pain reduction. Range of motion impairment usually persists. The surgical technique is challenging, but the quality of the bone graft is superior to the pediculated bone grafts of the distal radius. In addition, the distal femur offers the possibility of a osteocartilaginous graft to replace the complete proximal pole. Frequently, salvage surgery like 4 corner fusion can be avoided by this technique.

Arthroscopically Assisted 4-Corner Fusion

Objective: Four-corner fusion (4CF) is an accepted and effective procedure for managing several degenerative disorders of the wrist. This procedure consists of the excision of the entire scaphoid in association with midcarpal fusion of the remaining carpal bones (lunate, triquetrum, capitate, and hamate), and it is generally performed through an open approach. The combination of a minimal volar approach, for scaphoid excision, with arthroscopy preparation of midcarpal joint surfaces plus bone graft placing and percutaneous fixation techniques can, potentially, generate the best possible functional outcome by minimizing the effect of extra-articular adhesion related to open surgery. The purpose of this retrospective study is to present the arthroscopically assisted 4CF performed in our practice and to evaluate the clinical and radiographic results. Materials and Methods: Eleven patients underwent scaphoidectomy and 4CF. In each case, the scaphoidectomy was performed through a minimal volar approach, and the midcarpal joint surfaces were denuded through dry arthroscopy. The regular midcarpal portals were used. The bone graft was prepared from the excised scaphoid, and it was placed in midcarpal space using a 3.4 mm burr cannula. The fixation was achieved using headless cannulated compression screws. In the postoperative period, patients were put in a splint for 2 weeks. Range of motion exercises began 2 weeks after operation. Functional outcomes were assessed by objective and subjective measures: range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, visual analogue scale (VAS) of pain, satisfaction, and return to work. The x-rays were evaluated for union. The mean follow-up was of 20 months. Results: Mean surgery time was 2 hours. There was no need for conversion to the classic open procedure in any patient. The average flexion was of 44° (range, 30°-70°) and extension was of 39° (range, 10°-50°). Grip strength averaged 23 kg (62% of the other hand). Terminal to terminal pinch averaged 5.8 kg and terminal to lateral pinch was 7.3 kg (89% and 88% of the other hand, respectively). The mean QuickDASH score improved postoperatively from 40 to 10. Mean VAS postoperative pain rating was 2, compared with 7 preoperatively. All the patients were satisfied and were able to return to their previous activities. Fusion was achieved in every patient, confirmed by x-rays taken at 10 months postoperative. We had a surgery-related complication, a second-degree burn related with the use of the burr, which resolved with dressings, and there was a breakage of a screw in 1 patients, but in both cases fusion was achieved. Conclusion: Although technically demanding, in our opinion, the arthroscopically assisted 4CF seems a valid alternative to the classic 4CF procedure. The preliminary results seem promising, but longer follow-up is needed to confirm the benefits of this technique.

Four corner fusion using a multidirectional angular stable locking plate.

To review the results of our experience with the Medartis Aptus plating system for four corner arthrodesis of the wrist, which uses a combination of compression screws and variable angle locking screws. We reviewed the results of 17 procedures in 16 patients that underwent scaphoid excision and four corner fusion using the Medartis Aptus system between May 2010 and June 2014. The primary outcome measure was radiographic and clinical union. The mean clinical follow up time was 20.6 mo. The mean union time was 6 mo. Two non-unions required revision procedures. The mean disabilities of the arm, shoulder and hand score taken after union was 36. The mean final grip strength was 27 kg. The mean final range of movement was 30° flexion and 31° of extension. All patients had a restored scapholunate angle on postoperative radiographs. There were no incidences of dorsal impingement. Overall our experience with the Aptus plating system shows comparable results to other methods of fixation for four corner fusion, in the short to medium term.

Retrospective study of two fixation methods for 4-corner fusion: Shape-memory staple vs. dorsal circular plate

The purpose of this study was to compare the results of two groups of patients with four-corner fusion, one group fixed with shape-memory staples and the other with locked circular plates. This retrospective study compared 52 wrists operated for scaphoid excision and four-corner fusion between 2005 and 2011. The arthrodesis was ensured by a shape-memory quadripodal staple (4Fusion®, Memometal™) in 37 cases and a locking dorsal circular plate (Xpode®, Biotech Ortho™) in 15 cases. In the staple group, the mean age was 58.5 years and the average follow-up was 4.3 years. In the circular plate group, the mean age was 58.6 years and the average follow-up was 3.1 years. Pain, range of motion, grip strength, functional scores (QuickDASH and PWRE), fusion of the midcarpal joint, complications (implant fracture and reoperation) and patients’ satisfaction were used as outcome measures. There was no pain in 43% of patients in the staple group and 40% of patients in the circular plate group at the follow-up; range of motion and functional scores were similar in both groups. Seventy-five percent of patients in the staple group were satisfied or very satisfied versus 60% in the circular plate group. The implant broke in 24.3% of cases in the staple group and 60% in the circular plate group. Reoperation was needed in 18% of the staple cases and 14% of the plate cases. There was no difference between the implants in terms of pain, range of motion, functional scores and patient satisfactory. The implant fracture rate in the plate group was high. This study brings into question implant reliability for the four-corner fusion procedure.

Die mediokarpale Teilarthrodese des Handgelenkes mit retrograden kopflosen Kompressionsschrauben

This article describes our technique of 4-corner fusion using retrograde insertion of headless compression screws.

Buying Time: Long-term Results of Wrist Denervation and Need for Revision Surgery: Level 4 Evidence

Buying Time: Long-term Results of Wrist Denervation and Need for Revision Surgery: Level 4 Evidence