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Zoccolan A, Ferrari E, Vitali F, Ursino C, Zotta I, Rivellino MC, Greco D, Formica M. Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis-A Retrospective Comparative Study with Minimum 2 Years of Follow-up. Indian J Orthop 2024; 58:794-801. [PMID: 38812875 PMCID: PMC11130084 DOI: 10.1007/s43465-024-01127-1] [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] [Received: 09/05/2022] [Accepted: 02/25/2024] [Indexed: 05/31/2024]
Abstract
Purpose Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II-III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Materials and Methods Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. Results A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared. Conclusions The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level of Evidence Level III, Retrospective comparative study.
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Affiliation(s)
- Andrea Zoccolan
- Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100 Savona, Italy
| | - Emilio Ferrari
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Federico Vitali
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Chiara Ursino
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Irene Zotta
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
- APSS Santa Chiara, Largo Medaglie d’oro, 9, 38122 Trento, Italy
| | | | - Davide Greco
- Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100 Savona, Italy
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
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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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Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis. J Hand Surg Am 2020; 45:85-94.e2. [PMID: 31839367 DOI: 10.1016/j.jhsa.2019.10.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) are common salvage procedures for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse. This study aimed to assess rates of reoperation and conversion to wrist fusion and to assess the factors associated with reoperation and conversion to wrist fusion for patients treated with PRC and FCA. METHODS A retrospective chart review was performed evaluating 266 adult patients undergoing PRC or FCA at a single institutional system from 2002 to 2016. Demographic data, patient- and injury-specific data, reoperation and conversion rates, and complications were collected. Potential factors associated with reoperation or wrist fusion were evaluated using a bivariate, followed by a multivariable, analysis. RESULTS Reoperation was more commonly performed in FCA (34%) than in PRC (11%) (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.7-6.8) and occurred at a shorter postoperative interval. In a multivariable analysis for reoperation, manual labor was associated with reoperation in patients undergoing FCA (OR, 5.4; 95% CI, 1.5-19.1). In those undergoing PRC, anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was associated with a lower rate of reoperation (OR, 0.18; 95% CI, 0.06-0.57). In a multivariable analysis for conversion to wrist arthrodesis, intraoperative AIN and/or PIN neurectomy (OR, 0.18; 95% CI, 0.06-0.57) was associated with a lower rate of conversion to wrist fusion, and smoking (OR, 4.9; 95% CI, 1.8-13.5) was associated with a higher rate of conversion to wrist fusion. In the subanalysis of patients who underwent PRC, only AIN and/or PIN neurectomy was associated with lower rates of conversion to wrist arthrodesis (OR, 0.15; 95% CI, 0.04-0.56). CONCLUSIONS In our cohort, we observed that AIN and/or PIN neurectomy reduced the risk of reoperation and conversion to wrist arthrodesis after PRC. Smoking increased the odds of conversion to wrist arthrodesis in the combined PRC/FCA cohort; however, it is unclear whether this was due to smoking itself or whether the indications for PRC or FCA were affected, leading to this result. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Luchetti R. Proximal row carpectomy, scaphoidectomy with midcarpal arthrodesis or midcarpal tenodesis: when and how to use. J Hand Surg Eur Vol 2018; 43:579-588. [PMID: 29788805 DOI: 10.1177/1753193418775067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
I report my personal experience over three decades in the treatment of carpal collapse due to scapholunate collapse and scaphoid nonunion. I have used the proximal carpal row resection performed through palmar approach, the scaphoidectomy and double-column midcarpal arthrodesis, and scaphoidectomy with midcarpal tenodesis. Diagnostic arthroscopy is essential for staging and surgical decision making regarding the type of treatment. The details of the surgical techniques, tips, results and possible complications are described for each method. The advantage of the proximal row carpectomy by palmar approach is the early permitted rehabilitation with better recovery of wrist motility in comparison with the traditional technique. The advantage of the double-column midcarpal arthrodesis lies in its ease of execution. The midcarpal tenodesis is an excellent intervention from the conceptual point of view even if over time there is a progressive carpal collapse even in absence of symptoms.
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Bellemère P, Aribert M, Choughri H, Leroy M, Gaisne E. Treatment of Pisotriquetral Arthritis by Pyrocarbon Interposition Arthroplasty. J Wrist Surg 2018; 7:2-10. [PMID: 29383269 PMCID: PMC5788751 DOI: 10.1055/s-0037-1612635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Purpose Pisiformectomy is the baseline treatment for pisotriquetral arthritis when medical treatment fails to address the problem. This operation may lead to loss of mobility and strength in the wrist. This study reports the short-term outcomes of a new technique for treating pisotriquetral arthritis using a pisotriquetral interposition arthroplasty with a pyrocarbon implant. Patients and Methods We performed a clinical and radiographic study on a series of eight patients who received this treatment at a mean follow-up of 2.8 years. We also studied the mobility of the implant and did assessed articular instability using dynamic radiology and fluoroscopy. Results We observed one proximal dislocation of the implant in one hand which was reoperated to reposition the implant and strengthen the capsule. All patients were satisfied or very satisfied with their operation and had an average functional recovery period of 1.6 months. At the last follow-up, the Mayo Wrist Score (MWS), Quick Disability of Arm Shoulder and Hand (QDASH), and Patient-Rated Wrist Evaluation (PRWE) scores were 89, 18, and 20, respectively. Postoperatively, there was a 22% improvement in the grip strength of the wrists as well as improved mobility, mainly as regards the radioulnar deviation (47% improvement) and the Visual Analogue Scale (VAS) pain scores decreased from 8 preoperatively to 2 at the latest follow-up. The functional radiologic and fluoroscopic study reported good adaptive mobility of the implant in all the patients, without any indication of pisotriquetral joint instability. Conclusion The short-term results of pisotriquetral arthroplasty using the Pyrocardan implant are encouraging. This new surgical solution appears to be a valid alternative to pisiformectomy or pisotriquetral arthrodesis. Long-term studies are required to confirm these preliminary findings.
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Affiliation(s)
- Philippe Bellemère
- Institut de la Main Nantes-Atlantique, Clinique Jeanne-d'Arc, Nantes, France
| | - Marion Aribert
- Service de Chirurgie de la Main et des Brûlés, CHU de Grenoble—Hôpital Nord—Albert-Michallon, La Tronche, France
| | - Hussein Choughri
- Service de Chirurgie Plastique, Main et Brûlés, Centre François Xavier Michelet, CHU de Bordeaux—Pellegrin, Bordeaux, France
| | - Marc Leroy
- Institut de la Main Nantes-Atlantique, Clinique Jeanne-d'Arc, Nantes, France
| | - Etienne Gaisne
- Institut de la Main Nantes-Atlantique, Clinique Jeanne-d'Arc, Nantes, France
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Rancy SK, Trehan SK, Li AE, Lee SK, Potter HG, Wolfe SW. The Prevalence of Pisotriquetral Arthritis in the Setting of Scapholunate Advanced Collapse. J Wrist Surg 2016; 5:261-264. [PMID: 27777815 PMCID: PMC5074835 DOI: 10.1055/s-0036-1579749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/04/2016] [Indexed: 12/21/2022]
Abstract
Background Previous authors have reported pisotriquetral pain and subsequent pisiform excision following partial or total wrist fusion in patients with scapholunate advanced collapse (SLAC). Prior studies have not considered the potential role of SLAC biomechanics on pisotriquetral osteoarthritis (PT OA) development preoperatively. Purpose To determine the prevalence and severity of PT OA in patients with SLAC as compared with a control population. Patients and Methods Magnetic resonance imaging (MRI) studies of 24 patients with SLAC wrist and 24 sex- and age-matched control patients were analyzed. Patients with SLAC wrist were selected from a database of all wrist MRI studies performed at our institution from 2006 to 2015, excluding those with inflammatory arthritis, chondrocalcinosis, and incomplete or atraumatic scapholunate interosseous ligament rupture. Control patients underwent MRI for nonarthritic clinical indications and were chosen in an age- and sex-matched fashion. Patients undergoing MRI for triangular fibrocartilage complex injury, extensor carpi ulnaris tendinopathy, or ulnar-sided wrist pain were excluded from the control cohort. MRI grading of arthritic change at the pisotriquetral joint was assessed by a blinded musculoskeletal radiologist according to a four-category scale, with grade 4 indicating the greatest arthritic severity. Results The prevalence of PT OA in the control cohort was found to be 37.5% compared with 41.7% in the SLAC cohort. The prevalence of greatest arthritic severity (grade 4) at the pisotriquetral joint was found to be 4.2% in the control cohort, compared with 16.7% in the SLAC cohort. Conclusion We conclude that the overall prevalence of chondral wear at the pisotriquetral joint in SLAC wrist does not differ significantly from that found in control populations. We did identify a fourfold (but not statistically significant) increased prevalence of end-stage arthritis in patients with SLAC. Given reports of symptomatic PT OA developed following four-corner arthrodesis, we recommend preoperative vigilance for pisotriquetral pain in patients with SLAC arthritis. Level of Evidence Prognostic level III.
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Affiliation(s)
- Schneider K. Rancy
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Samir K. Trehan
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Angela E. Li
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Steve K. Lee
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Scott W. Wolfe
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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Delattre O, Goulon G, Vogels J, Wavreille G, Lasnier A. Three-Corner Arthrodesis With Scaphoid and Triquetrum Excision for Wrist Arthritis. J Hand Surg Am 2015; 40:2176-82. [PMID: 26409577 DOI: 10.1016/j.jhsa.2015.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the clinical and radiographic results of a consecutive series of patients who underwent the 3-corner arthrodesis (3CA) (arthrodesis of capitate, hamate, and lunate with scaphoid and triquetrum excision) procedure for wrist arthritis. METHODS This was a retrospective study of 30 consecutive patients who underwent a 3CA between 1994 and 2008. The indications were painful wrist osteoarthritis due to stage 2 or 3 scapholunate advanced collapse, scaphoid nonunion advanced collapse, or scaphoid chondrocalcinosis advanced collapse wrists. The clinical assessment consisted of range of motion, grip strength, and the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores. The radiographic assessment parameters consisted of bone fusion, carpal height and translation, lunate tilt, and appearance of the radiolunate joint space. RESULTS The average follow-up was 6 years (± 4 years). The arthrodesis was performed with staples, 2 screws, or a plate and screws. Grip strength was 72% of the contralateral side. The mean range of motion in flexion-extension arc and ulnar-radial deviation arc was 70° and 36°, respectively. The mean Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation scores were 17 (± 11) and 22 (± 24), respectively. The fusion incidence was 90% (27 of 30). The mean difference of radiolunate angle on preoperative and postoperative radiographs was 8° (16°-8° in dorsal direction). The radiolunate joint space had narrowed in 1 patient. Six surgical revisions (20%) were necessary owing to dorsal pain in patients operated using plates, staples, or excessively long screws. CONCLUSIONS Three-corner arthrodesis results are comparable with 4-corner arthrodesis and proximal row carpectomy. We feel that it is simpler technically than 4-corner arthrodesis. Although 3CA is more complex than proximal row carpectomy, it preserves the native radiolunate joint. Complications that can be attributed to the dorsal fixation hardware (particularly staples and plates) were noteworthy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Olivier Delattre
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Gilles Goulon
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Jérôme Vogels
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | | | - Arthur Lasnier
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France.
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Trail IA, Murali R, Stanley JK, Hayton MJ, Talwalkar S, Sreekumar R, Birch A. The long-term outcome of four-corner fusion. J Wrist Surg 2015; 4:128-133. [PMID: 25945298 PMCID: PMC4408128 DOI: 10.1055/s-0035-1549277] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Four-corner arthrodesis with excision of the scaphoid is an accepted salvage procedure for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) and has been performed in our unit for over 20 years. We have undertaken a retrospective review of 116 of these procedures performed in 110 patients between 1992 and 2009. Fifty-eight patients attended for a clinical evaluation, and 29 responded by postal questionnaire. Methods The surgical technique undertaken was standard. That is, through a dorsal approach the scaphoid and tip of the radial styloid were excised. The capitate, lunate, triquetrum, and hamate articular surfaces were then prepared down to bleeding bone. Bone grafts from the scaphoid and radial styloid were then inserted and fixation undertaken. For the latter, various methods were used, including Kirschner (K-)wires, staples, bone screws, but predominantly the Spider plate (Integra Life Sciences, USA). Thereafter the wrist was immobilized for a minimum period of 2 weeks prior to rehabilitation. Results Follow-up was done at a mean of 9 years and 4 months (range 3-19 years). All patients reported a significant improvement in pain relief and ∼50% of flexion extension, although only 40% of radioulnar deviation. Grip strength was again ∼50% of the contralateral side. Most patients reported a significant improvement in function with 87% returning to work. In addition, radiologic evaluation identified 28 patients (31%) who demonstrated ongoing signs of nonunion, particularly around the triquetrum. Fourteen of these (15%) underwent a further procedure, generally with success. Finally, none of the patients demonstrated any arthritic changes in the lunate fossa on follow-up X-ray, and all secondary procedures were undertaken within 2 years of the primary. Discussion This research has demonstrated that four-corner fusion fixed with a circular plate can result in a satisfactory outcome with a reduction in pain, a functional range of motion, and a satisfactory functional outcome. The bulk of the complications appear to occur in the first 2 years after surgery. Thereafter, analysis shows long-term satisfaction with little deterioration. Nonunion, particularly around the triquetrum, continues to be a problem, but it may be that this bone should be excised along with the scaphoid, resulting in a three-part fusion only. Alternatively, a simple capitolunate fusion may be satisfactory.
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Affiliation(s)
- Ian A. Trail
- Wrightington Hospital, Lancashire, United Kingdom
| | - Raj Murali
- Wrightington Hospital, Lancashire, United Kingdom
| | | | | | | | | | - Ann Birch
- Wrightington Hospital, Lancashire, United Kingdom
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Giannikas D, Karageorgos A, Karabasi A, Syggelos S. Capitolunate arthrodesis maintaining carpal height for the treatment of SNAC wrist. J Hand Surg Eur Vol 2010; 35:198-201. [PMID: 20031996 DOI: 10.1177/1753193409352280] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The clinical and radiological results of a modified midcarpal fusion technique for scaphoid nonunion advance collapse were retrospectively studied in eight patients. All had partial resection of the proximal part of the fractured scaphoid, limited radial styloidectomy, scaphocapitate and lunocapitate arthrodesis, using a block of iliac crest graft to maintain carpal height. All united without complications and wrist motion, grip strength and carpal height were improved postoperatively. The modified Mayo wrist score at follow-up was 70%. Three patients continued to have some pain and one patient had a poor result.
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Affiliation(s)
- D Giannikas
- Orthopaedic Department, Patras University Hospital, Rio-Patras, Greece.
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Gaston RG, Greenberg JA, Baltera RM, Mih A, Hastings H. Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2009; 34:1407-12. [PMID: 19733983 DOI: 10.1016/j.jhsa.2009.05.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 05/20/2009] [Accepted: 05/27/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthrodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis. METHODS We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strength; visual analog scale (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthroplasty, and pisotriquetral arthritis were recorded. RESULTS Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strength, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision. CONCLUSIONS Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strength, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the lunate following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concern with this technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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