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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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Andronic O, Labèr R, Kriechling P, Karczewski D, Flury A, Nagy L, Schweizer A. Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases. J Plast Surg Hand Surg 2023; 57:29-37. [PMID: 35522840 DOI: 10.1080/2000656x.2022.2070182] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND Four-corner fusion (4CF) is a known treatment option for degenerative wrist conditions. Different techniques may be used and there is no general consensus on best implant. As such, it was the purpose of the current systematic review to compare fusion rates and outcomes depending on the fixation technique. METHODS The systematic review was registered in the international prospective register of systematic reviews (PROSPERO): CRD42020164301. It followed the PRISMA guidelines. Original articles were screened using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and Web of Science Core Collection. Studies reporting on outcome for 4CF surgery were included. Studies with a minimum Level IV of evidence were considered eligible. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS A total of 29 studies met the inclusion criteria, for a total of 1103 wrists. The mean age was 41.8 years (range 19-83). Mean follow-up overall was 43.5 months (range 24-146 months). Reported fusion weighted rates were >90% and did not differ significantly between techniques. Reoperations due to different reasons occurred in 135 (12%) of all 1103. There was significant data heterogeneity regarding fusion rates (I2 = 70%). Inconsistency and heterogeneity in data reporting did not allow meta-analysis with direct data pooling and comparison of subgroups. CONCLUSIONS Satisfactory fusion rates (over 90%) can be achieved independent of the fixation technique used in 4-corner arthrodesis. Due to the high data heterogeneity and reporting inconsistency across studies, no statements regarding PROMs, ROM or grip strength can be made. LEVEL OF EVIDENCE Systematic Review of Level IV Studies.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Raffael Labèr
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
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Athlani L, Cholley-Roulleau M, Blum A, Teixeira PAG, Dap F. Intercarpal arthrodesis: A systematic review. HAND SURGERY & REHABILITATION 2023; 42:93-102. [PMID: 36642245 DOI: 10.1016/j.hansur.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
| | - A Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - P A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
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Mevel G, De Geyer A, Kim W, Ebalard M, Ropars M, Dreano T. Four-corner arthrodesis using the 4Fusion® quadripodal shape memory staple: a long-term review. J Hand Surg Eur Vol 2022; 47:387-392. [PMID: 34851782 DOI: 10.1177/17531934211063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series.Level of evidence: IV.
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Affiliation(s)
- Gwenaël Mevel
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Aymeric De Geyer
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Warren Kim
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Maud Ebalard
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Mickaël Ropars
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Thierry Dreano
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
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Andronic O, Nagy L, Burkhard MD, Casari FA, Karczewski D, Kriechling P, Schweizer A, Jud L. Long-term outcomes of the four-corner fusion of the wrist: A systematic review. World J Orthop 2022; 13:112-121. [PMID: 35096541 PMCID: PMC8771412 DOI: 10.5312/wjo.v13.i1.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/26/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Four-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF.
AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.
METHODS The systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.
RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.
CONCLUSION The 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Marco D Burkhard
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Fabio A Casari
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Daniel Karczewski
- Department of Trauma and Orthopaedics, Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin 10117, Germany
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
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