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Lozano A, Cointat C, Bouju Y, Kerjean Y, Lecoq FA, Bellemère P. Amandys® versus four-corner fusion in patients aged over 50 years: long-term retrospective study in stage 3 wrist osteoarthritis. J Hand Surg Eur Vol 2024:17531934241275480. [PMID: 39275972 DOI: 10.1177/17531934241275480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
We compared the outcomes of the Amandys® implant and four-corner fusion in patients aged over 50 years with grade 3 wrist osteoarthritis and a mean follow-up of 5 years. Clinical assessments were of pain, mobility, strength, functional scores and satisfaction. Radiographs were taken. A total of 46 patients (mean age 63 years; 28 four-corner fusion and 21 Amandys®) were included. Pain relief, mobility and functional scores were not significantly different in the two groups at inclusion. At the last follow-up, wrist extension and grip were improved after Amandys® arthroplasty. Flexion decreased after four-corner fusion. One patient in the Amandys® group was not satisfied and one dislocation required repositioning of the implant. There were six nonunions, of which one required revision surgery in the four-corner fusion group. With the Amandys®, immobilization was shorter and mobility improved, making it a valid alternative to four-corner fusion especially in older patients.Level of evidence: IV.
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Affiliation(s)
- Aude Lozano
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
- Service de Chirurgie de la Main et Reconstruction de l'appareil locomoteur, Centre Chirurgical Emile Gallé, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Caroline Cointat
- Service de Chirurgie orthopédique et Chirurgie du Sport, Institut Universitaire Locomoteur et du Sport (iULS), CHU de Nice, Nice, France
| | - Yves Bouju
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Yves Kerjean
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Flore-Anne Lecoq
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Philippe Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
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Andronic O, Labèr R, Kriechling P, Karczewski D, Flury A, Nagy L, Schweizer A. Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases. J Plast Surg Hand Surg 2023; 57:29-37. [PMID: 35522840 DOI: 10.1080/2000656x.2022.2070182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Four-corner fusion (4CF) is a known treatment option for degenerative wrist conditions. Different techniques may be used and there is no general consensus on best implant. As such, it was the purpose of the current systematic review to compare fusion rates and outcomes depending on the fixation technique. METHODS The systematic review was registered in the international prospective register of systematic reviews (PROSPERO): CRD42020164301. It followed the PRISMA guidelines. Original articles were screened using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and Web of Science Core Collection. Studies reporting on outcome for 4CF surgery were included. Studies with a minimum Level IV of evidence were considered eligible. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS A total of 29 studies met the inclusion criteria, for a total of 1103 wrists. The mean age was 41.8 years (range 19-83). Mean follow-up overall was 43.5 months (range 24-146 months). Reported fusion weighted rates were >90% and did not differ significantly between techniques. Reoperations due to different reasons occurred in 135 (12%) of all 1103. There was significant data heterogeneity regarding fusion rates (I2 = 70%). Inconsistency and heterogeneity in data reporting did not allow meta-analysis with direct data pooling and comparison of subgroups. CONCLUSIONS Satisfactory fusion rates (over 90%) can be achieved independent of the fixation technique used in 4-corner arthrodesis. Due to the high data heterogeneity and reporting inconsistency across studies, no statements regarding PROMs, ROM or grip strength can be made. LEVEL OF EVIDENCE Systematic Review of Level IV Studies.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Raffael Labèr
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
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Athlani L, Cholley-Roulleau M, Blum A, Teixeira PAG, Dap F. Intercarpal arthrodesis: A systematic review. HAND SURGERY & REHABILITATION 2023; 42:93-102. [PMID: 36642245 DOI: 10.1016/j.hansur.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
| | - A Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - P A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
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Hayes E, Cheng Y, Sauder D, Sims L. Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review. J Hand Surg Am 2022; 47:477.e1-477.e9. [PMID: 34253392 DOI: 10.1016/j.jhsa.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 03/30/2021] [Accepted: 06/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the union rates and clinical outcomes of 4-corner arthrodesis with different methods of osteosynthesis. METHODS A systematic review of studies published in Ovid, Medline, Embase, and PubMed was conducted. Primary studies that reported clinical and radiographic results following 4-corner arthrodesis for scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), or other types of wrist arthritis in human subjects were eligible. Biomechanical or cadaveric studies, case reports, studies that did not define and report a radiographic union rate, reviews and technical articles, studies that did not report the method of osteosynthesis, and studies that used multiple methods of osteosynthesis, but did not separate results for individual methods of osteosynthesis were excluded. Radiographic union rate, range of motion, and grip strength were analyzed. RESULTS We identified and reviewed 291 full texts, selecting 57 studies for coding. The radiographic union rate did not significantly differ between studies using K-wire, screw, staple, nonlocking plate, metal locking plate, and radiolucent locking plate osteosynthesis. Fixation method significantly affected flexion, but pairwise comparison did not reveal any significant differences between individual groups. Grip strength as a percentage of the contralateral limb was significantly lower in studies with metal locking plate fixation compared to K-wire fixation (63.2% vs 82.6%). There were no other statistically significant differences between groups with respect to flexion, extension, radial deviation, ulnar deviation, and grip strength. CONCLUSIONS All methods of osteosynthesis result in similar union rates, with no significant differences between methods. While there are some significant differences in range of motion and grip strength, these differences are unlikely to be clinically relevant. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Emmitt Hayes
- University of Saskatchewan College of Medicine, Saskatoon, Canada
| | - Yanzhao Cheng
- Division of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Canada
| | - David Sauder
- Division of Orthopedic Surgery, University of Saskatchewan College of Medicine, Royal University Hospital, Saskatoon, Canada
| | - Laura Sims
- Saskatoon Orthopedic and Sports Medicine Centre, Saskatoon, Canada.
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Mevel G, De Geyer A, Kim W, Ebalard M, Ropars M, Dreano T. Four-corner arthrodesis using the 4Fusion® quadripodal shape memory staple: a long-term review. J Hand Surg Eur Vol 2022; 47:387-392. [PMID: 34851782 DOI: 10.1177/17531934211063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series.Level of evidence: IV.
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Affiliation(s)
- Gwenaël Mevel
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Aymeric De Geyer
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Warren Kim
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Maud Ebalard
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Mickaël Ropars
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Thierry Dreano
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
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Melibosky FR, Jorquera RA, Saxton FZ, Orellana P, Junqueras D, Azócar C. Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1739239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique.
Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications.
Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score.
Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group.
Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.
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Affiliation(s)
- Francisco R. Melibosky
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Rene A. Jorquera
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Felipe Z. Saxton
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
| | - Pablo Orellana
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Diego Junqueras
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
- Hand Surgery Unit, Department of Traumatology and Orthopedics, Hospital de la Florida, Santiago, Chile
| | - Camila Azócar
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
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Vande Voorde K, Caekebeke P, Duerinckx J. Scaphoidectomy and 4-corner arthrodesis with headless compression screws: results, complications and their treatment. Acta Orthop Belg 2021; 87:771-777. [PMID: 35172447 DOI: 10.52628/87.4.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.
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d'Almeida MA, Sturbois-Nachef N, Amouyel T, Chantelot C, Saab M. Four-corner fusion: Clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years' follow-up. Orthop Traumatol Surg Res 2021; 107:102886. [PMID: 33711508 DOI: 10.1016/j.otsr.2021.102886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Among the various procedures for degenerative carpal lesions, four-corner fusion relieves pain while conserving motion and strength. There are various fixation options, not presently standardised. HYPOTHESIS Internal fixation by screws or dorsal locking plate provides good 5-year clinical results in four-corner fusion. MATERIAL AND METHOD A single-centre retrospective study included 18 four-corner fusions at a minimum 5 years' follow-up: 8 plate and 10 screw fixations. Endpoints comprised pain, wrist range of motion, grip strength, QuickDASH and PRWE scores, and immobilisation time. Radiographic analysis was performed and complications inventoried. RESULTS Pain VAS score fell to 1/10 in both groups. Flexion-extension was 56° with screws and 55° with plates. QuickDASH was 20.5 and 4.6 respectively, and PRWE 11 and 9. Grip strength was 16kg in both groups. The consolidation rate was 85.7% with screws and 57.1% with plates. Eighty percent of patients with screw fixation progressed toward radiolunate osteoarthritis. Four patients required revision surgery: 3 in the screw group and 1 in the plate group. DISCUSSION There was clear clinical and functional improvement in both groups at a minimum 5 years. Consolidation was better with screw fixation, but with risk of radiolunate osteoarthritis. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
| | | | - Thomas Amouyel
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Christophe Chantelot
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
| | - Marc Saab
- Service d'orthopédie 1, Hôpital Roger-Salengro, rue Émile-Laine, 59000 Lille, France
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Marie C, Aribert M, Bouyer M, Forli A, Corcella D. Clinical, functional, and radiological results of the Amandys® interposition arthroplasty in 13 cases of wrist osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40:420-426. [PMID: 33689925 DOI: 10.1016/j.hansur.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022]
Abstract
Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.
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Affiliation(s)
- C Marie
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Aribert
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Bouyer
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - A Forli
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - D Corcella
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
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Mechanical performance comparison of two surgical constructs for wrist four-corner arthrodesis via dorsal and radial approaches. Clin Biomech (Bristol, Avon) 2021; 82:105274. [PMID: 33508561 DOI: 10.1016/j.clinbiomech.2021.105274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Four-corner arthrodesis, which involves fusing four carpal bones while removing the scaphoid bone, is a standard surgery for the treatment of advanced stages of wrist arthritis. Nowadays, it can be performed using a dorsal approach by fixing a plate to the bones and a new radial approach is in development. To date, there is no consensus on the biomechanically optimal and most reliable surgical construct for four-corner arthrodesis. METHODS To evaluate them biomechanically and thus assist the surgeon in choosing the best implant orientation, radial or dorsal, the two different four-corner arthrodesis surgical constructs were virtually simulated on a 3D finite element model representing all major structures of the wrist. Two different realistic load sets were applied to the model, representing common tasks for the elderly. FINDINGS Results consistency was assessed by comparing with the literature the force magnitude computed on the carpal bones. The Von Mises stress distribution in the radial and dorsal plates were calculated. Stress concentration was located at the plate-screw interface for both surgical constructs, with a maximum stress value of 413 MPa for the dorsal plate compared to 326 MPa for the radial plate, meaning that the stress levels are more unfavourable in the dorsal approach. INTERPRETATION Although some bending stress was found in one load case, the radial plate was mechanically more robust in the other load case. Despite some limitations, this study provides, for the first time, quantified evidence that the newly developed radial surgical construct is mechanically as efficient as the dorsal surgical construct.
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Pomares G. Trapeziometacarpal osteoarthritis and arthritis of the wrist. HAND SURGERY & REHABILITATION 2021; 40S:S135-S142. [PMID: 33482390 DOI: 10.1016/j.hansur.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be taken into consideration when treating osteoarthritis at the base of the thumb. The coexistence of these lesions determines the entire surgical strategy. Failure to take them into account during the surgical treatment often results in a compromised postoperative course and it often adversely impacts the outcome of secondary surgeries.
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Affiliation(s)
- G Pomares
- European Hand Institute Luxembourg - Kirchberg Hospital, 9, Edward Steichen Street, 2540 Luxembourg, Luxembourg.
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12
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Zenke Y, Oshige T, Menuki K, Hirasawa H, Yamanaka Y, Tajima T, Kosugi K, Sakai A. Four-corner fusion method using a bioabsorbable plate for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists: a case series study. BMC Musculoskelet Disord 2020; 21:683. [PMID: 33059663 PMCID: PMC7565362 DOI: 10.1186/s12891-020-03709-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Scaphoid excision and four-corner arthrodesis is an acceptable salvage procedure for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, since first popularized in the 1980s. We investigated the potential application of novel bioabsorbable plates and screws made of un-sintered hydroxyapatite/poly-L-lactide composite for the treatment of metacarpal fractures. We used this material for the fixation of four-corner fusions for SLAC or SNAC wrists commencing from April 2009. The purpose of this study was to clarify the controversy in the literature regarding the use of these plates. Methods The surgical procedures and clinical outcomes of four-corner fusions using a bioabsorbable (poly-L-lactic acid and hydroxyapatite) plate were reported. Ten patients (mean age, 59.2 years) with SLAC or SNAC wrists underwent fusions between April 2009 and June 2016. The primary diseases were scapholunate ligament injury, Preiser disease, and scaphoid pseudarthrosis. The mean postoperative follow-up period was 45.9 months (range, 12–86). Results In all patients, bone union was achieved without dislocation or pain. The mean wrist flexion and extension arc improved from 78.5 degrees before surgery to 90.5 degrees after surgery. Mean grip strength improved from 51 to 69% after surgery, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score improved from 53.5 to 14.3. No complications such as infection, avascular swelling, or tendon adhesion were observed. This implant requires no removal of internal fixation devices, produces stable outcomes, and is an effective fusion technique. Conclusions We summarized the outcomes of four-corner arthrodesis using bioabsorbable plates. Satisfactory clinical results were shown, with no obvious complications. This novel plate also serves as a good alternative for patients who are allergic to metals. Furthermore, bioabsorbable plates are advantageous as they do not require removal.
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Affiliation(s)
- Yukichi Zenke
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan.
| | - Toshihisa Oshige
- Department of Orthopaedic Surgery, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Kunitaka Menuki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan
| | - Hideyuki Hirasawa
- Department of Orthopaedic Surgery, Tokyo Rosai Hospital, Tokyo, Japan
| | - Yoshiaki Yamanaka
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan
| | - Takafumi Tajima
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan
| | - Kenji Kosugi
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan
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Athlani L, Sabau S, Pauchard N, Dap F, Dautel G. Four-corner arthrodesis with a dorsal locking plate: 4-9-year follow-up. J Hand Surg Eur Vol 2020; 45:673-678. [PMID: 32536296 DOI: 10.1177/1753193420930587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the outcomes of four-corner arthrodesis for advanced wrist collapse in 50 patients (51 wrists) using a dorsal locking plate. At a mean follow-up of 6 years (range 4-9), pain was significantly reduced and wrist function was significantly improved compared with preoperative status. After four-corner arthrodesis, grip strength was 80% of the contralateral side, and wrist motion averaged 50° flexion-extension and 30° radioulnar deviation. Immobilization time was 5 weeks (4-6) and sick-leave was 3 months (2-5) following surgery. There were seven nonunions (14%) that underwent repeat arthrodesis. Three wrists were later converted to total arthrodesis due to persisting pain. Radiographic dorsal impingement was found in five wrists after four-corner arthrodesis and did not require reoperation. The outcomes appear not remarkably different from those reported using other fixation methods other than an apparent earlier return to activities.Level of evidence: IV.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Sophie Sabau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Nicolas Pauchard
- Service de chirurgie de la main - SOS main, Hôpital privé Dijon, Bourgogne, France
| | - François Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
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Eder C, Scheller A, Schwab N, Krapohl BD. Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes ®): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2019; 8:Doc15. [PMID: 31815084 PMCID: PMC6883383 DOI: 10.3205/iprs000141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Long persisting scaphoid non-unions or scapholunate ligament ruptures can lead to carpal collapse. The resulting clinical symptoms are restrictions in the range of motion, pain, and loss of grip strength. The symptomatic treatment so far offers different options. In our study, the Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate) by Synthes® was used in 11 cases of advanced carpal collapse for a four-corner fusion of the wrist. The intra- and postoperative as well as follow-up results have been assessed and compared with those of current literature. The results of the Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M²-Dash) showed an average of 41.5 points (MD=44/SD=16.62/MIN=21/MAX=65). One of the re-evaluated patients complained about pain at rest. One patient stated pain after mild strain; 4 patients complained pain after heavy burden (e.g. boxing, weight lifting). Measuring the range of motion, the operated hand showed a maximum in dorsal extension of 78.31% and in flexion of 57.89% compared to the contralateral, non-operated hand. In performance testing the fist clenching sign as well as pinch grip were complete and void of pain in 100%, whereas opposition (dig. man. I to V) was complete in five patients (83.33%), with moderate pain in one patient (16.67%) and a persisting gap of 0.2 cm in n=1 (16.67%). In comparison with the current literature regarding healing rates, complications, and follow-up results, we recommend the Synthes® VA LCP ICF Plate as a good surgical option in patients suffering from advanced carpal collapse.
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Affiliation(s)
- Christian Eder
- Centre for Musculoskeletal Surgery, Charité - Medical University, Campus Virchow Clinic, Berlin, Germany
| | - Ariane Scheller
- Centre for Musculoskeletal Surgery, Charité - Medical University, Campus Virchow Clinic, Berlin, Germany
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Rimokh J, Benazech B, Lebeau N, Haddad B, Moughabghab M, David E. Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four-corner arthrodesis with locking plate. HAND SURGERY & REHABILITATION 2019; 39:36-40. [PMID: 31751792 DOI: 10.1016/j.hansur.2019.10.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/15/2019] [Accepted: 10/01/2019] [Indexed: 12/21/2022]
Abstract
The treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist varies. No clear consensus exists on surgical indications. Scaphoid excision and four-corner arthrodesis with locking plate is one of preferred treatments for these lesions. The purpose of this study was to assess the clinical and radiological outcomes of locking plates for treating SNAC and SLAC wrist after a mean follow-up of 5 years and to compare these outcomes with the results reported in the literature. A retrospective study was conducted in two hospitals, involving 40 patients who underwent scaphoid excision and four-corner arthrodesis with locking plate between January 2006 and September 2016. All patients were reviewed as outpatients with clinical and radiographic measurements. At the last follow-up, the mean pain level on visual analog scale (VAS) was 2.5/10 [0-7] (SD: 1.7). Patients had a mean flexion of 46% and a mean extension of 46% compared to the contralateral side. An 18% gain was observed in grip strength. The mean postoperative QuickDASH score was 30 [0-57] (SD: 15.3). Seventy percent of patients were satisfied with the operation. Complete (all four joint interfaces) joint space fusion was achieved in 55% of patients. Only one patient (2.5%) had no joint fusion. The joint between the lunate and the capitate was fused in 38 patients (95%). Nine patients suffered complications; eight of them required surgical revision (20%). Four-corner arthrodesis with locking plate is a valuable surgical technique for treating SLAC and SNAC wrist because it preserve satisfactory range of motion and grip strength (64% compared to the non-operated side), maintains the height of the carpus and prevents the premature appearance of radiocarpal osteoarthritis, as long as the technical challenges of this procedure are mastered.
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Affiliation(s)
- J Rimokh
- Chirurgie orthopédique, university hospital Center of Amiens, avenue Rene Laennec, 80480 Salouel, France.
| | - B Benazech
- Chirurgie orthopédique, university hospital Center of Amiens, avenue Rene Laennec, 80480 Salouel, France
| | - N Lebeau
- Saint Quentin Hospital Center, 1, avenue Michel de l'Hospital, 02321 Saint-Quentin, France
| | - B Haddad
- Chirurgie orthopédique, university hospital Center of Amiens, avenue Rene Laennec, 80480 Salouel, France
| | - M Moughabghab
- Saint Quentin Hospital Center, 1, avenue Michel de l'Hospital, 02321 Saint-Quentin, France
| | - E David
- Chirurgie orthopédique, university hospital Center of Amiens, avenue Rene Laennec, 80480 Salouel, France
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Erne HC, Broer PN, Weiss F, Loew S, Cerny MK, Schmauss D, Ehrl DC. Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations. J Plast Reconstr Aesthet Surg 2019; 72:909-917. [DOI: 10.1016/j.bjps.2018.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 12/21/2022]
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Daar DA, Shah A, Mirrer JT, Thanik V, Hacquebord J. Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis. Plast Reconstr Surg 2019; 143:1432-1445. [PMID: 31033826 DOI: 10.1097/prs.0000000000005558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist. METHODS A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed. RESULTS Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model. CONCLUSIONS Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint.
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Affiliation(s)
- David A Daar
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Ajul Shah
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Joshua T Mirrer
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Vishal Thanik
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Jacques Hacquebord
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
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Odella S, Querenghi AM, Locatelli FM, Dacatra U, Creta E, Tos P. Locking Dorsal Plate in Four-Bone Arthrodesis in SLAC and SNAC 3 Wrist. JOINTS 2018; 6:37-41. [PMID: 29675505 PMCID: PMC5906121 DOI: 10.1055/s-0038-1626738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/02/2018] [Indexed: 01/21/2023]
Abstract
Purpose The aim of this study was to evaluate the effectiveness and the safety of performing a four-bone arthrodesis (FBA) with dorsal locking plate in patients suffering from stage III scapholunate advanced collapse/scaphoid nonunion advance collapse (SLAC/SNAC) wrist. Methods We evaluated retrospectively 20 patients surgically treated by a FBA with the use of locking dorsal plate. All the patients were clinically evaluated at follow-up for grip strength, range of motion, and pain (visual analog scale), and with the Disability of the Arm, Shoulder and Hand score and the Mayo wrist score. Imaging evaluation was performed on standard X-rays. Results The mean follow-up was 6 years (range: 1-11 years). During follow-up, the patients showed good clinical outcomes in terms of pain relief and grip strength. Revision surgery was necessary only in one case because of screws loosening. In all cases, a solid bone fusion was achieved except in one patient, who presented a healing of lunocapitate joint. This condition did not affect the clinical outcomes. Conclusion FBA performed using a dorsal locking plate is a salvage procedure effective in treating stage III SLAC/SNAC wrist. In our study, this technique provided good clinical outcomes at mid-term follow-up with a very low complication rate. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Simona Odella
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
| | - Amos M. Querenghi
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
| | - Francesco M. Locatelli
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
| | - Ugo Dacatra
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
| | - Elia Creta
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
| | - Pierluigi Tos
- Operative Unit of Microsurgery and Hand Surgery, Ospedale Gaetano Pini–CTO, Milan, Italy
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Tielemans A, Van Innis F, Troussel S, Detrembleur C, Libouton X, Lequint T. Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines. HAND SURGERY & REHABILITATION 2017; 36:186-191. [DOI: 10.1016/j.hansur.2017.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/07/2017] [Accepted: 01/12/2017] [Indexed: 12/14/2022]
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