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Clinical Orthopaedics and Related Research®

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01-10-2012 | Clinical Research

Effectiveness of Four-Corner Arthrodesis with Use of a Locked Dorsal Circular Plate

Authors: Matthias Luegmair, MD, Patrick Houvet, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 10/2012

Abstract

Background

Compared with traditional methods of fixation in four-corner arthrodesis, reviews of results using a dorsal circular plate (DCP) have identified higher complication rates. As the use of circular plate fixation for limited wrist arthrodesis was found to be a valuable concept per se and continued innovation and technical advancement are crucial to improve future treatment, changes in plate design were encouraged.

Questions/purposes

To further evaluate the use of DCP fixation in four-corner arthrodesis, we report the first results using a radiolucent, nonmetallic (polyetheretherketone), locked DCP for four-corner arthrodesis.

Methods

We retrospectively analyzed the clinical and radiographic results of 24 patients who underwent four-corner arthrodesis with a locked DCP at a minimum followup of 63 months (mean, 76 months; range, 63–91 months). There were nine women and 15 men, with a mean age of 53 years (range, 37–78 years) at the time of surgery. We evaluated ROM with a goniometer and grip strength with a dynamometer. Function was assessed using QuickDASH. Radiographs were evaluated for union, carpal alignment, and hardware problems.

Results

At latest followup, ROM averaged 66% and 77% of the uninjured side in flexion-extension and radioulnar deviation, respectively. Grip strength averaged 70% of the uninjured side. The average postoperative QuickDASH score was 19.11. Union was achieved by 22 of the 24 patients.

Conclusions

Our data show four-corner arthrodesis with a radiolucent, nonmetallic, locked DCP is an effective procedure that allows stable primary fixation as a basis for good functional outcome, provided surgical technique and quality of bone graft are adequate.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Amadio PC. Outcomes assessment in hand surgery. What’s new? Clin Plast Surg. 1997;24:191–194.PubMed

Ashmead D 4th, Watson HK, Damon C, Herber S, Paly W. Scapholunate advanced collapse wrist salvage. J Hand Surg Am. 1994;19:741–750.PubMedCrossRef

Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am. 2010;35:719–725.PubMedCrossRef

Bedford B, Yang SS. High fusion rates with circular plate fixation for four-corner arthrodesis of the wrist. Clin Orthop Relat Res. 2010;468:163–168.PubMedCrossRef

Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for surgical exposure of the wrist. Ann Plast Surg. 1995;35:54–59.PubMedCrossRef

Blankenhorn BD, Pfaeffle HJ, Tang P, Robertson D, Imbriglia J, Goitz RJ. Carpal kinematics after proximal row carpectomy. J Hand Surg Am. 2007:32:37–46.PubMedCrossRef

Chen C, Chandnani VP, Kang HS, Resnick D, Sartoris DJ, Haller J. Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology. 1990;177:459–461.PubMed

Chung KC, Watt AJ, Kotsis SV. A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity. Plast Reconstr Surg. 2006;118:433–442.PubMedCrossRef

Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am. 2001;26:94–104.PubMedCrossRef

10.

DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am. 2004;86:2359–2365.PubMed

11.

Hogan CJ, McKay PL, Degnan GG. Changes in radiocarpal loading characteristics after proximal row carpectomy. J Hand Surg Am. 2004;29:1109–1113.PubMedCrossRef

12.

Kendall CB, Brown TR, Millon SJ, Rudisill LE Jr, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am. 2005;30:903–907.PubMedCrossRef

13.

Kraisarin J, Dennison DG, Berglund LJ, An KN, Shin AY. Biomechanical comparison of three fixation techniques used for four-corner arthrodesis. J Hand Surg Eur Vol. 2011;36:560–567.PubMedCrossRef

14.

Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am. 1994;19:751–759.PubMedCrossRef

15.

Linscheid RL, Rettig ME. The treatment of displaced scaphoid nonunion with trapezoidal bone graft. In: Gelberman RH, ed. Master Techniques in Orthopaedic Surgery: The Wrist. New York, NY: Raven Press; 1994:119–131.

16.

Matheson LN, Melhorn JM, Mayer TG, Theodore BR, Gatchel RJ. Reliability of a visual analog version of the QuickDASH. J Bone Joint Surg Am. 2006;88:1782–1787.PubMedCrossRef

17.

Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am. 2008;33:635–642.PubMedCrossRef

18.

Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol. 2009;34:256–263.PubMedCrossRef

19.

Resnick D, Niwayama G. Carpal instability in rheumatoid arthritis and calcium pyrophosphate deposition disease: pathogenesis and roentgen appearance. Ann Rheum Dis. 1977;36:311–318.PubMedCrossRef

20.

Romano S. [Non-traumatic osteoarthritis of the wrist: chondrocalcinosis] [in French]. Chir Main. 2003;22:285–292.PubMedCrossRef

21.

Saffar P. Chondrocalcinosis of the wrist. J Hand Surg Br. 2004;29:486–493.PubMedCrossRef

22.

Shin AY. Four-corner arthrodesis. J Am Soc Surg Hand. 2001;1:93–111.CrossRef

23.

Shindle MK, Burton KJ, Weiland AJ, Domb BG, Wolfe SW. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur Vol. 2007;32:50–53.PubMedCrossRef

24.

Strauch RJ. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis: update on evaluation and treatment. J Hand Surg Am. 2011;36:729–735.PubMedCrossRef

25.

Tomaino MM, Miller RJ, Cole I, Burton RJ. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg Am. 1994;19:134–142.PubMedCrossRef

26.

Vance MC, Hernandez JD, DiDonna ML, Stern PJ. Complications and outcome of four-corner arthrodesis: circular plate fixation versus traditional techniques. J Hand Surg Am. 2005;30:1122–1127.PubMedCrossRef

27.

Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9:358–365.PubMed

28.

Watson HK, Goodman ML, Johnson TR. Limited wrist arthrodesis. Part II: Intercarpal and radiocarpal combinations. J Hand Surg Am. 1981;6:223–233.PubMed

29.

Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg Br. 1999;24:307–315.PubMedCrossRef

30.

Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am. 1995;20:965–970.PubMedCrossRef

Title: Effectiveness of Four-Corner Arthrodesis with Use of a Locked Dorsal Circular Plate
Authors: Matthias Luegmair, MD
Patrick Houvet, MD
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 10/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2312-9

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Springer Medicine

Effectiveness of Four-Corner Arthrodesis with Use of a Locked Dorsal Circular Plate

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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