Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases

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.

Fibulo-Scapho-Lunate Arthrodesis With Free Vascularized Fibular Graft for a Japanese Kyudo Archer With Osteosarcoma of the Left Distal Radius: A Case Report

BACKGROUND

Recent progress in the chemotherapy and surgical procedures for osteosarcoma have enabled the preservation of limb function even when cancer occurs in the distal radius, a rare primary site of osteosarcoma.

CASE REPORT

We describe a case of osteosarcoma that occurred in an 18-year-old, male Kyudo (Japanese archery) archer's left distal radius. Since the patient desired to resume Kyudo and the left hand was quite important for gripping a bow, we chose partial wrist arthrodesis (fibulo-scapho-lunate arthrodesis) with free vascularized fibular grafting (FVFG) as the reconstruction procedure following wide resection. After the wide resection, the major axis of bone defect was 8 cm. We harvested a free vascularized fibular graft with fascio-cutaneous flap with wide fascia to reconstruct the gliding surface of the extensor tendon. Fibula-proximal radius and fibulo-scapho-lunate fixation was performed by locking plates individually. Vascular anastomosis was performed between the radial artery and peroneal artery in a flow-through manner. Two peroneal veins were anastomosed with the radial vein and cephalic vein.

CONCLUSION

Fibulo-scapho-lunate arthrodesis with FVFG may provide satisfied stability and function even in a Kyudo archer. The patient obtained sufficient wrist stability and grip strength, and could resume Kyudo.

Arthroscopic three-corner or lunocapitate arthrodesis: technical tips and early outcomes

The purpose of the study is to present a technical approach for arthroscopic three-corner or lunocapitate arthrodesis with mini-open scaphoid excision and to report about the early clinical and functional results. The median surgery time was 112 min with shorter times achieved once mastering the technique. Radiological and clinical union was observed in 11 out of 12 patients in a median time of five months. For final assessments nine patients were included with a median follow-up of 15 months. Wrist extension and flexion after surgery decreased to 58 and 62% of preoperative measurements and represented 37 and 42% of the unaffected side. Grip strength also decreased to 80% of the preoperative value and 57% of the unaffected side. All patients reported significant pain relief and functional improvement. Arthroscopic three-corner or lunocapitate arthrodesis was a safe, reliable and minimally invasive technique for treating wrist osteoarthritis, while it was technically demanding and time-consuming during learning curve.

Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up

Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term.

LEVEL OF EVIDENCE

IV.