Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review

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.

Scaphotrapeziotrapezoid Arthrodesis Using Limited Wrist Fusion Plates in Kienböck's Disease

PURPOSE

The purpose of this study was to evaluate the clinical and radiological results of scaphotrapeziotrapezoid (STT) arthrodesis with a limited wrist fusion plate in patients with Stage IIIB Kienböck's disease (KD).

MATERIALS AND METHODS

A retrospective review was performed on nine patients with Stage IIIB KD who underwent STT arthrodesis between 2014 and 2017 at our institution. Clinical evaluations of the patients were made using the shortened quick version of the Disabilities of the Arm, Shoulder, and Hand (Q-DASH) Outcome Measure score (Institute for Work and Health, Toronto, ON, Canada) and grip strength measurements before surgery and at the final follow-up examination. All patients underwent computed tomography (CT) scan to confirm the union of the arthrodesis.

RESULTS

A complete union was obtained in all patients. The Q-DASH score was changed from 57.8 ± 8.2 points (range: 47.7 - 70.5) to 32.3 ± 17.3 points (range: 13.6 - 54.5) (p = 0.008). Similarly, the grip strength was improved significantly (p = 0.007).

CONCLUSIONS

The use of limited wrist fusion plates for STT arthrodesis in KD is a safe and effective treatment method that provides a high rate union and acceptable functional results.

A blinded, randomized trial comparing bicolumnar arthrodesis to radioscapholunate arthrodesis in scapholunate advanced collapse II arthritis: a pilot study

The purpose of this study was to compare the outcome of scaphoid excision with capitolunate and triquetrohamate arthrodesis (bicolumnar arthrodesis) to radioscapholunate arthrodesis in patients with scapholunate advanced collapse (SLAC) II wrist arthritis. Twelve patients with symptomatic SLAC II arthritis were recruited and randomized to receive either bicolumnar arthrodesis or radioscapholunate arthrodesis. The primary outcome was wrist function as assessed by the patient rated wrist evaluation. Secondary outcomes included range of motion, grip strength and the Mayo wrist score. A linear mixed-effects model was used to evaluate the effects of bicolumnar arthrodesis and radioscapholunate arthrodesis in treating SLAC II arthritis. Patients receiving bicolumnar arthrodesis had more improvement in their wrist function compared with patients receiving radioscapholunate arthrodesis. A high rate of re-operation was observed in patients receiving radioscapholunate arthrodesis. In SLAC II arthritis, the expected benefit of preserving the midcarpal joint was not observed. Scapholunate ligament disruption makes radioscapholunate arthrodesis a technically challenging operation.

LEVEL OF EVIDENCE

I.

Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up

The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10-19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial-ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome.

LEVEL OF EVIDENCE

IV.