Abstract
Background: Four-corner fusion of the wrist is an option for management of non-union scaphoid with painful arthritis of the wrist. Various surgical techniques have been devised for four-corner fusion, with inconsistent results. We present our experience of four-corner fusion achieved using a standard H-plate, designed originally for anterior cervical plating.
Materials and Methods: The study is a retrospective analysis of six cases of painful wrist arthritis resulting from nonunion of scaphoid treated by four-corner fusion, between 1996 and 2004. The average duration of follow-up was 5.8 years. Each patient was evaluated clinically according to the rating scales described by Bach.
Results: The mean grip-strength calculated as a percentage of the uninvolved side was 47% pre-operatively, and 74% post-operatively at the final follow-up. The difference between the preoperative and postoperative ‘pain ratings’ and ‘activity ratings’ was found to be statistically significant (P<0.001). Mean time to fusion was 16.1 weeks. Dorsal impingement was the most common associated problem.
Conclusions: H-plate, used for four-corner fusion, provides rigid fixation, ensures fusion, and is a good alternative to the available options.
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References
Enna M, Hoepfner P, Weiss AP. Scaphoid excision with fourcorner fusion. Hand Clin 2005;21:531–8.
Abbot LC, Saunders CM, Bost FC. Arthrodesis of the wrist with the use of grafts of cancellous bone. J Bone Joint Surg 1942;24:883–98.
Inglis AE, Jones EC. Proximal row carpectomy for diseases of the proximal row. J Bone Joint Surg Am 1977;59:460–3.
Lukas B, Herter F, Englert A, Backer K. The treatment of carpal collapse: Proximal row carpectomy or limited midcarpal arthrodesis? A comparative study. Handchir Mikrochir Plast Chir 2003;35:304–9.
Wyrick J, Stern P, Kiefhaber T. Motion preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four corner arthrodesis. J Hand Surg Am 1995;20:965–70.
Watson KH, Ballet FL. The SLAC wrist: Scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984;9:358–65.
Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am 1994;19:751–9.
Chung KC, Watt AJ, Kotsis SV. 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 2006;118:433–42.
Kendall CB, Brown TR, Millon SJ, Rudisill LE, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2006;31:327–8.
Bach AW, Almquist EE, Newman DM. Proximal row fusion as a solution for radiocarpal arthritis. J Hand Surg Am 1991;16:424–31.
Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Longterm results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg 2006;56:139–44.
El-Mowafi H, El-Hadidi M, Boghdady GW, Hasanein EY. Functional outcome of four-corner arthrodesis for treatment of grade IV scaphoid non-union. Acta Orthop Belg 2007;73:604–11.
Garcia-López A, Perez-Ubeda MJ, Marco F, Molina M, López-Duran L. A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist). J Hand Surg Br 2001;26:352–4.
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;30:1122–7.
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Gupta, R.K., Chauhan, D.S. & Singh, H. Non-union scaphoid: Four-corner fusion of the wrist. IJOO 44, 208–211 (2010). https://doi.org/10.4103/0019-5413.61908
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DOI: https://doi.org/10.4103/0019-5413.61908