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Archives of Orthopaedic and Trauma Surgery

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01-04-2016 | Handsurgery

Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate

Authors: J. F. Hernekamp, A. Reinecke, F. Neubrech, B. Bickert, U. Kneser, T. Kremer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2016

Abstract

Background

Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation.

Methods

21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis.

Results

No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications.

Conclusion

Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.

Watson HK, Goodman ML, Johnson TR (1981) Limited wrist arthrodesis. Part II: intercarpal and radiocarpal combinations. J Hand Surg 6(3):223–233CrossRef

Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW (2014) Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Euro Vol. doi:10.1177/1753193414554359

Dacho AK, Baumeister S, Germann G, Sauerbier M (2008) Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr aesthetic Surg JPRAS 61(10):1210–1218. doi:10.1016/j.bjps.2007.08.007 CrossRef

Shindle MK, Burton KJ, Weiland AJ, Domb BG, Wolfe SW (2007) Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Euro 32(1):50–53. doi:10.1016/j.jhsb.2006.08.016 CrossRef

Collins ED, Nolla J (2008) Spider plate fixation: no significant improvement in limited wrist arthrodesis. Techn Hand Upper Extr Surg 12(2):94–99. doi:10.1097/BTH.0b013e31815e4580 CrossRef

Chung KC, Watt AJ, Kotsis SV (2006) 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 118(2):433–442. doi:10.1097/01.prs.0000227737.90007.5d CrossRefPubMed

Neubrech F, Muhldorfer-Fodor M, Pillukat T, Schoonhoven J, Prommersberger KJ (2012) Long-term results after midcarpal arthrodesis. J Wrist Surg 1(2):123–128. doi:10.1055/s-0032-1329616 CrossRefPubMedPubMedCentral

Germann G, Wind G, Harth A (1999) The DASH(Disability of Arm-Shoulder-Hand) Questionnaire–a new instrument for evaluating upper extremity treatment outcome. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 31(3):149–152. doi:10.1055/s-1999-13902

Berger RA, Bishop AT, Bettinger PC (1995) New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 35(1):54–59CrossRefPubMed

10.

Tunnerhoff HG, Haussmann P (2005) Partial midcarpal arthrodesis with excision of the scaphoid for the treatment of advanced carpal collapse. Oper Orthop und Traumatol 17(3):233–248. doi:10.1007/s00064-005-1131-5 CrossRef

11.

Bain GI, Watts AC (2010) The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of 10 years. J Hand Surg 35(5):719–725. doi:10.1016/j.jhsa.2010.01.025 CrossRef

12.

Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D (1999) One thousand intercarpal arthrodeses. J Hand Surg 24(3):307–315. doi:10.1054/jhsb.1999.0066 CrossRef

13.

Strauch RJ (2011) Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis–update on evaluation and treatment. J Hand Surg 36(4):729–735. doi:10.1016/j.jhsa.2011.01.018 CrossRef

14.

Friedel R, Lenz M, Donicke T, Hofmann G (2011) Midcarpal fusion with the spider plate. Oper Orthop Traumatol 23(2):98–104. doi:10.1007/s00064-011-0020-3 CrossRefPubMed

15.

Garcia-Lopez A, Perez-Ubeda MJ, Marco F, Molina M, Lopez-Duran L (2001) A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist). J Hand Surg 26(4):352–354. doi:10.1054/jhsb.2001.0598 CrossRef

16.

Gonzalez Del Pino J, Campbell D, Fischer T, Vazquez FN, Jupiter JB, Nagy L (2012) Variable angle locking intercarpal fusion system for four-corner arthrodesis: indications and surgical technique. J Wrist Surg 1(1):73–78. doi:10.1055/s-0032-1323640 CrossRefPubMedPubMedCentral

17.

Khan SK, Ali SM, McKee A, Jones JW (2013) Outcomes of four-corner arthrodesis using the Hubcap circular plate. Hand Surg Int J Dev Hand Upper Limb Surg Relat Res J Asia–Pacific Feder Soc Surg Hand 18(2):215–220. doi:10.1142/S0218810413500263

18.

Zeplin PH, Kuhfuss I (2009) Midcarpal arthrodesis with cortical bolting chip for treatment of grade II/III scaphoid non-union and scapholunate advanced collapse. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 41(3):183–185. doi:10.1055/s-2008-1039118

19.

Vance MC, Hernandez JD, Didonna ML, Stern PJ (2005) Complications and outcome of four-corner arthrodesis: circular plate fixation versus traditional techniques. J Hand Surg 30(6):1122–1127. doi:10.1016/j.jhsa.2005.08.007 CrossRef

20.

Dacho A, Grundel J, Holle G, Germann G, Sauerbier M (2006) Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg 56(2):139–144. doi:10.1097/01.sap.0000194245.94684.54 CrossRefPubMed

21.

Kitzinger HB, Low S, Karle B, Lanz U, Krimmer H (2003) The posttraumatic carpal collapse–long-term results after midcarpal fusion. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 35(5):282–287. doi:10.1055/s-2003-43116

22.

Krimmer H, Sauerbier M, Vispo-Seara JL, Schindler G, Lanz U (1992) Advanced carpal collapse (SLAC-wrist) in scaphoid pseudarthrosis. Therapy concept: medio-carpal partial arthrodesis. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 24 (4):191–198

23.

Dt Ashmead, Watson HK, Damon C, Herber S, Paly W (1994) Scapholunate advanced collapse wrist salvage. J Hand Surg 19(5):741–750CrossRef

24.

Krimmer H, Wiemer P, Kalb K (2000) Comparative outcome assessment of the wrist joint–mediocarpal partial arthrodesis and total arthrodesis. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 32(6):369–374. doi:10.1055/s-2000-10915

25.

Sauerbier M, Trankle M, Linsner G, Bickert B, Germann G (2000) Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment. J Hand Surg 25(4):341–345. doi:10.1054/jhsb.2000.0434 CrossRef

26.

Sauerbier M, Kluge S, Bickert B, Germann G (2000) Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienbock’s disease. Chir Main 19(4):223–231CrossRefPubMed

27.

Unglaub F, Manz S, Leclere FM, Dragu A, Hahn P, Wolf MB (2011) Clinical outcome of rearthrodesis in cases of non-union following four-corner fusion. Arch Orthop Trauma Surg 131(11):1567–1572. doi:10.1007/s00402-011-1339-9 CrossRefPubMed

Title: Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate
Authors: J. F. Hernekamp
A. Reinecke
F. Neubrech
B. Bickert
U. Kneser
T. Kremer
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 4/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2416-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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