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J Wrist Surg 2018; 07(03): 262-266
DOI: 10.1055/s-0037-1607072
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Midterm Results of Four-Corner Fusion Using Dorsal Circular Plate Fixation

Ahmed Elgammal
1   Department of Hand, Elbow and Plastic Surgery, Schön Klinik München Harlaching, Muenchen, Germany
2   Department of Orthopedics, Ain Shams University Hospitals, Al Waili, Cairo Governorate, Egypt
,
Claus J. Deglmann
1   Department of Hand, Elbow and Plastic Surgery, Schön Klinik München Harlaching, Muenchen, Germany
,
Vanja Celigoj
1   Department of Hand, Elbow and Plastic Surgery, Schön Klinik München Harlaching, Muenchen, Germany
,
Bernhard Lukas
1   Department of Hand, Elbow and Plastic Surgery, Schön Klinik München Harlaching, Muenchen, Germany
› Author Affiliations Funding None.
Further Information

Publication History

12 April 2017

22 August 2017

Publication Date:
16 October 2017 (online)

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Abstract

Purpose The purpose of this prospective study was to evaluate the results of four-corner fusion using dorsal circular plate.

Methods We operated on 20 patients between 2009 and 2011.

Results At a mean follow-up period of 30 months (range: 14–62, SD: 16), the mean VAS improved from 8 (range: 4–10, SD: 2) preoperatively to 4 (range: 0–8, SD: 2). Function measured with the DASH score improved from 37 (range: 10–75, SD: 18) to 26 (range: 2.5–64, SD: 19). Eighteen patients in our series showed full consolidation and two patients showed persistent nonunion. Three cases required plate removal due to dorsal impingement.

Conclusion  Four-corner fusion using dorsal circular plate showed satisfactory results in this study, but it did not show superior results compared with simpler fixation methods mentioned in the literature, such as K-wires or screw fixation. Currently, we are principally using K-wires as a fixation method of choice in our four-corner fusion procedures.

Level of Evidence  Level II.

Keywords

four-corner fusion - scapholunate advanced collapse - scaphoid nonunion advanced collapse
 

  • References

  • 1 Bisneto EN, Freitas MC, Paula EJ, Mattar Jr R, Zumiotti AV. Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study. Clinics (Sao Paulo) 2011; 66 (01) 51-55
    CrossrefPubMedGoogle Scholar
  • 2 Ashmead IV D, Watson HK, Damon C, Herber S, Paly W. Scapholunate advanced collapse wrist salvage. J Hand Surg Am 1994; 19 (05) 741-750
    CrossrefPubMedGoogle Scholar
  • 3 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 (01) 94-104
    CrossrefPubMedGoogle Scholar
  • 4 Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am 1994; 19 (05) 751-759
    CrossrefPubMedGoogle Scholar
  • 5 Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?. J Hand Surg Am 1994; 19 (01) 134-142
    CrossrefPubMedGoogle Scholar
  • 6 Trumble T, Bour CJ, Smith RJ, Edwards GS. Intercarpal arthrodesis for static and dynamic volar intercalated segment instability. J Hand Surg Am 1988; 13 (03) 384-390
    CrossrefPubMedGoogle Scholar
  • 7 Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg Br 1999; 24 (03) 307-315
    CrossrefPubMedGoogle Scholar
  • 8 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 (06) 965-970
    CrossrefPubMedGoogle Scholar
  • 9 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 10 Bedford B, Yang SS. High fusion rates with circular plate fixation for four-corner arthrodesis of the wrist. Clin Orthop Relat Res 2010; 468 (01) 163-168
    CrossrefPubMedGoogle Scholar
  • 11 Dutly-Guinand M, von Schroeder HP. Three-corner midcarpal arthrodesis and scaphoidectomy: a simplified volar approach. Tech Hand Up Extrem Surg 2009; 13 (01) 54-58
    CrossrefPubMedGoogle Scholar
  • 12 Espinoza DP, Schertenleib P. Four-corner bone arthrodesis with dorsal rectangular plate: series and personal technique. J Hand Surg Eur Vol 2009; 34 (05) 609-613
    CrossrefPubMedGoogle Scholar
  • 13 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 (06) 1122-1127
    CrossrefPubMedGoogle Scholar
  • 14 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 (02) 256-263
    CrossrefPubMedGoogle Scholar
  • 15 Enna M, Hoepfner P, Weiss AP. Scaphoid excision with four-corner fusion. Hand Clin 2005; 21 (04) 531-538
    CrossrefPubMedGoogle Scholar
  • 16 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
    PubMedGoogle Scholar
  • 17 Hudak PL, Amadio PC, Bombardier C. ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
    CrossrefPubMedGoogle Scholar
  • 18 Kendall CB, Brown TR, Millon SJ, Rudisill Jr LE, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2005; 30 (05) 903-907
    CrossrefPubMedGoogle Scholar
  • 19 Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10 (01) 39-46
    CrossrefPubMedGoogle Scholar
  • 20 Ryu JY, Cooney III WP, Askew LJ, An KN, Chao EY. Functional ranges of motion of the wrist joint. J Hand Surg Am 1991; 16 (03) 409-419
    PubMedGoogle Scholar