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J Wrist Surg 2023; 12(03): 225-231
DOI: 10.1055/s-0042-1757448
Scientific Article

Four-Corner Arthrodesis with a Dorsal Locking PEEK Plate: A Retrospective Case Series

Emmitt Hayes 
1   Division of Orthopedic Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
,
David A. Leswick 
2   Department of Medical Imaging, Saskatchewan Health Authority, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
Haron Obaid 
2   Department of Medical Imaging, Saskatchewan Health Authority, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
David A. Sauder
3   Division of Orthopedic Surgery, Royal University Hospital, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
4   Saskatoon Orthopedic and Sports Medicine Center, Saskatoon, Saskatchewan, Canada
› Author Affiliations Funding Funding for this study was provided by the University of Saskatchewan College of Medicine Dean's Research Project Bursary. The funding source did not have any involvement in the study design, data collection, or writing of the manuscript.
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Abstract

Background Four-corner arthrodesis (4CA) can be performed with a variety of methods. To our knowledge, fewer than 125 cases of 4CA with a locking polyether ether ketone (PEEK) plate have been reported, necessitating further study.

Purpose The purpose of this study was to evaluate the radiographic union rate and clinical outcomes in a series of patients who received 4CA with a locking PEEK plate.

Methods We re-examined 39 wrists in 37 patients at a mean follow-up of 50 months (median: 52 months, range: 6–128). Patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and participated in measurements of grip strength and range of motion. Anteroposterior, lateral, and oblique radiographs of the operative wrist were examined for union, screw breakage and/or loosening, and lunate change.

Results The mean QuickDASH score was 24.4 and the mean PRWE score was 26.5. Mean grip strength was 29.2 kg or 84% of the nonoperative hand. Mean flexion, extension, radial deviation, and ulnar deviation were : 37.2, 28.9, 14.1, and 17.4 degrees, respectively. Eighty-seven percent of wrists achieved union; 8% had nonunion; and5% had indeterminate union. There were seven cases of screw breakage and seven cases of screw loosening (as defined by lucency or bony resorption surrounding screws). Twenty-three percent of wrists required reoperation (four total wrist arthrodesis and five reoperations for other reasons).

Conclusion 4CA with a locking PEEK plate has clinical and radiographic outcomes similar to other methods. We observed a high rate of hardware complications. It is unclear whether this implant offers a clear advantage over other methods of fixation used in 4CA.

Type of Study/Level of Evidence Level IV, therapeutic study.

Keywords

dorsal locking PEEK plate - four-corner arthrodesis - 4CA - wrist arthrodesis - midcarpal joint fusion

Ethical Review

This study was approved by the University of Saskatchewan Biomedical Research Ethics Board (Bio-REB) in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.




Publication History

Received: 28 September 2021

Accepted: 17 August 2022

Article published online:
13 October 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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