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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2021; 49(02): e105-e114
DOI: 10.1055/s-0041-1739239
Original Article

Artrodesis de cuatro esquinas con placa circular dorsal bloqueada versus tornillos canulados de compresión sin cabeza: estudio clínico-radiológico comparativo

Artikel in mehreren Sprachen: English | español
Francisco R. Melibosky 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Rene A. Jorquera 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Felipe Z. Saxton 
2   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
,
Pablo Orellana 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
,
Diego Junqueras 
2   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
3   Hand Surgery Unit, Department of Traumatology and Orthopedics, Hospital de la Florida, Santiago, Chile
,
Camila Azócar 
1   Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
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Resumen

Introducción La artrodesis de cuatro esquinas es una técnica para el tratamiento de colapsos avanzados del carpo. Consiste en realizar una escafoidectomía asociada a artrodesis de los huesos semilunar, piramidal, ganchoso y grande. La cirugía se puede realizar con distintos tipos de osteosíntesis. En los primeros reportes de uso de las placas circulares dorsales, se describen malos resultados, con altas tasas de no unión, las cuales disminuyeron en los estudios posteriores, en los cuales se pone especial hincapié en puntos de la técnica quirúrgica.

Objetivo Reportar nuestra experiencia en la artrodesis de cuatro esquinas con el uso de una placa dorsal bloqueada (Xpode, Trimed Inc., Santa Clarita, CA, EEUU), y compararla con otro método de fijación tradicional (tornillos canulados de compresión sin cabeza de 3.0 mm, Synthes, Solothurn, Suiza), con énfasis en la consolidación, evaluación de resultados funcionales, y presencia complicaciones.

Material y Métodos Estudio comparativo de dos series de pacientes operados con dos técnicas distintas de osteosíntesis para una artrodesis de cuatro esquinas utilizando injerto autólogo de cresta iliaca.

En un primer grupo, evaluado entre el 2010 y el 2012, se usó osteosíntesis con 2 tornillos canulados de compresión sin cabeza, con un seguimiento mínimo de 18 meses, y en otro grupo, evaluado entre el 2011 y el 2014, se usó osteosíntesis con placa bloqueada dorsal, con un seguimiento mínimo de 12 meses. Estos fueron operados en cuatro centros por cuatro cirujanos distintos.

Se les evaluó con radiografías, para determinar la presencia de consolidación y el tiempo de la misma. En caso de duda, se certificó la consolidación con tomografía axial computarizada (TAC), a las ocho semanas postquirúrgicas. También se evaluaron los rangos de movimiento, la presencia de complicaciones, y la función con escalas las escalas de discapacidades del brazo, hombro y mano (Disabilities of the Arm, Shoulder and Hand, DASH, en inglés), y de fuerza de puño.

Resultados Logramos tasas de consolidación del 100% en ambos grupos, con tiempos similares. Destaca en el grupo de placas el mejor rango de movimiento total y en especial de la extensión, con una diferencia estadísticamente significativa (p = 0,0016), al igual que la obtención de puntajes de DASH más bajos, con una diferencia estadísticamente significativa (p = 0,0066). Sólo en el grupo de tornillos hubo dos casos de complicación de la osteosíntesis.

Conclusión Ambas técnicas son válidas y reproducibles para el tratamiento de las muñecas con colapso avanzado del carpo secundario a una lesión escafolunar (scapholunate advanced collapse, SLAC, en inglés) y colapso avanzado del carpo secundario a una no unión del escafoides (scaphoid non-union advanced collapse, SNAC, en inglés). Con base en los resultados, consideramos que, con la placa Xpode, los pacientes presentan mejores rangos de movimiento y puntajes en el DASH, por lo que puede ser una excelente alternativa para la artrodesis de cuatro esquinas con técnica abierta. La configuración y el sitio de entrada en el caso de usar tornillos son temas fundamentales a analizar.

La tasa de consolidación del 100% obtenida en este estudio contrasta con las altas tasas de no unión de las placas dorsales circulares reportadas en la bibliografía en los años 2000.

Palabras clave

SNAC - SLAC - artrodesis parcial del carpo - artrodesis de cuatro esquinas - placa bloqueada dorsal - tornillos canulados de compresión


Publikationsverlauf

Eingereicht: 05. Oktober 2020

Angenommen: 09. Juni 2021

Artikel online veröffentlicht:
13. Dezember 2021

© 2021. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Sawyer GA, Weiss A-PC. Scaphoid Excision and Four-Corner Arthrodesis. Tech Orthop 2009; 24 (01) 58-61
    CrossrefPubMedGoogle Scholar
  • 2 Lyons RP, Weiss A-PC. Scaphoid excision and four-corner fusion in the SLAC/SNAC wrist. Oper Tech Orthop 2003; 13 (01) 34-41
    CrossrefPubMedGoogle Scholar
  • 3 Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?. J Hand Surg Am 1994; 19 (01) 134-142
    CrossrefPubMedGoogle Scholar
  • 4 Campbell AC, Strick MJ. Coalition of the proximal row of the carpus. Ulster Med J 1994; 63 (01) 119-120
    PubMedGoogle Scholar
  • 5 Delaney TJ, Eswar S. Carpal coalitions. J Hand Surg Am 1992; 17 (01) 28-31
    CrossrefPubMedGoogle Scholar
  • 6 Resnik CS, Grizzard JD, Simmons BP, Yaghmai I. Incomplete carpal coalition. AJR Am J Roentgenol 1986; 147 (02) 301-304
    CrossrefPubMedGoogle Scholar
  • 7 Peterson HA, Lipscomb PR. Intercarpal arthrodesis. Arch Surg 1967; 95 (01) 127-134
    CrossrefPubMedGoogle Scholar
  • 8 Garcia-Elias M, Lluch A, Ferreres A, Papini-Zorli I, Rahimtoola ZO. Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg Am 2005; 30 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 9 McAuliffe JA, Dell PC, Jaffe R. Complications of intercarpal arthrodesis. J Hand Surg Am 1993; 18 (06) 1121-1128
    CrossrefPubMedGoogle Scholar
  • 10 Sutro CJ. Treatment of nonunion of the carpal navicular bone. Surgery 1946; 20: 536-540
    PubMedGoogle Scholar
  • 11 Shin AY. Four-corner arthrodesis. J Am Soc Surg Hand 2001; 1 (02) 93-111
    CrossrefPubMedGoogle Scholar
  • 12 Graner O, Lopes EI, Carvalho BC, Atlas S. Arthrodesis of the carpal bones in the treatment of Kienböck's disease, painful ununited fractures of the navicular and lunate bones with avascular necrosis, and old fracture-dislocations of carpal bones. J Bone Joint Surg Am 1966; 48 (04) 767-774
    CrossrefPubMedGoogle Scholar
  • 13 Watson HK. Limited wrist arthrodesis. Clin Orthop Relat Res 1980; (149) 126-136
    PubMedGoogle Scholar
  • 14 Watson HK, Hempton RF. Limited wrist arthrodeses. I. The triscaphoid joint. J Hand Surg Am 1980; 5 (04) 320-327
    CrossrefPubMedGoogle Scholar
  • 15 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 16 Richards AA, Afifi AM, Moneim MS. Four-corner fusion and scaphoid excision using headless compression screws for SLAC and SNAC wrist deformities. Tech Hand Up Extrem Surg 2011; 15 (02) 99-103
    CrossrefPubMedGoogle Scholar
  • 17 Pauchard N, Lecoanet-Strugarek C, Segret J, De Gasperi M, Dap F, Dautel G. Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study. Orthop Traumatol Surg Res 2014; 100 (06) 593-597
    CrossrefPubMedGoogle Scholar
  • 18 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (02) 256-263
    CrossrefPubMedGoogle Scholar
  • 19 Larsen CF, Jacoby RA, McCabe SJ. Nonunion rates of limited carpal arthrodesis: a meta-analysis of the literature. J Hand Surg Am 1997; 22 (01) 66-73
    CrossrefPubMedGoogle Scholar
  • 20 Enna M, Hoepfner P, Weiss AP. Scaphoid excision with four-corner fusion. Hand Clin 2005; 21 (04) 531-538
    CrossrefPubMedGoogle Scholar
  • 21 Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am 1995; 20 (06) 965-970
    CrossrefPubMedGoogle Scholar
  • 22 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
    PubMedGoogle Scholar
  • 23 Ashmead IV D, Watson HK, Damon C, Herber S, Paly W. Scapholunate advanced collapse wrist salvage. J Hand Surg Am 1994; 19 (05) 741-750
    CrossrefPubMedGoogle Scholar
  • 24 Allende BT. Osteoarthritis of the wrist secondary to non-union of the scaphoid. Int Orthop 1988; 12 (03) 201-211
    CrossrefPubMedGoogle Scholar
  • 25 Harrington RH, Lichtman DM, Brockmole DM. Common pathways of degenerative arthritis of the wrist. Hand Clin 1987; 3 (04) 507-527
    CrossrefPubMedGoogle Scholar
  • 26 Ruby LK, Leslie BM. Wrist arthritis associated with scaphoid nonunion. Hand Clin 1987; 3 (04) 529-539
    CrossrefPubMedGoogle Scholar
  • 27 Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am 1987; 12 (04) 514-519
    CrossrefPubMedGoogle Scholar
  • 28 Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1210-1218
    CrossrefPubMedGoogle Scholar
  • 29 De Smet L, Degreef I, Robijns F, Truyen J, Deprez P. Salvage procedures for degenerative osteoarthritis of the wrist due to advanced carpal collapse. Acta Orthop Belg 2006; 72 (05) 535-540
    PubMedGoogle Scholar
  • 30 Kiefhaber TR. Management of scapholunate advanced collapse pattern of degenerative arthritis of the wrist. J Hand Surg Am 2009; 34 (08) 1527-1530
    CrossrefPubMedGoogle Scholar
  • 31 Goldfarb CA, Stern PJ, Kiefhaber TR. Palmar midcarpal instability: the results of treatment with 4-corner arthrodesis. J Hand Surg Am 2004; 29 (02) 258-263
    CrossrefPubMedGoogle Scholar
  • 32 Resnick D, Niwayama G. Carpal instability in rheumatoid arthritis and calcium pyrophosphate deposition disease. Pathogenesis and roentgen appearance. Ann Rheum Dis 1977; 36 (04) 311-318
    CrossrefPubMedGoogle Scholar
  • 33 Chen C, Chandnani VP, Kang HS, Resnick D, Sartoris DJ, Haller J. Scapholunate advanced collapse: a common wrist abnormality in calcium pyrophosphate dihydrate crystal deposition disease. Radiology 1990; 177 (02) 459-461
    CrossrefPubMedGoogle Scholar
  • 34 Herzberg GCW. Perilunate fracture dislocations. The wrist: diagnosis and operative treatment. Vol 1. 1998: 651-83
    Google Scholar
  • 35 Lichtman DM, Bruckner JD, Culp RW, Alexander CE. Palmar midcarpal instability: results of surgical reconstruction. J Hand Surg Am 1993; 18 (02) 307-315
    CrossrefPubMedGoogle Scholar
  • 36 Wright TW, Dobyns JH, Linscheid RL, Macksoud W, Siegert J. Carpal instability non-dissociative. J Hand Surg [Br] 1994; 19 (06) 763-773
    CrossrefPubMedGoogle Scholar
  • 37 Watson HK, Goodman ML, Johnson TR. Limited wrist arthrodesis. Part II: Intercarpal and radiocarpal combinations. J Hand Surg Am 1981; 6 (03) 223-233
    CrossrefPubMedGoogle Scholar
  • 38 Shapiro JS. Power staple fixation in hand and wrist surgery: new applications of an old fixation device. J Hand Surg Am 1987; 12 (02) 218-227
    CrossrefPubMedGoogle Scholar
  • 39 Ozyurekoglu T, Turker T. Results of a method of 4-corner arthrodesis using headless compression screws. J Hand Surg Am 2012; 37 (03) 486-492
    CrossrefPubMedGoogle Scholar
  • 40 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 (06) 1122-1127
    CrossrefPubMedGoogle Scholar
  • 41 Kendall CB, Brown TR, Millon SJ, Rudisill Jr LE, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2005; 30 (05) 903-907
    CrossrefPubMedGoogle Scholar
  • 42 Bedford B, Yang SS. High fusion rates with circular plate fixation for four-corner arthrodesis of the wrist. Clin Orthop Relat Res 2010; 468 (01) 163-168
    CrossrefPubMedGoogle Scholar
  • 43 Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am 2008; 33 (05) 635-642
    CrossrefPubMedGoogle Scholar
  • 44 Weiss A-PC. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2006; 31 (02) 327-328 , author reply 328
    CrossrefPubMedGoogle Scholar
  • 45 Rhee PC, Kakar S, Shin AY. Four-corner arthrodesis with a locking, dorsal circular polyether-ether-ketone (PEEK-Optima) plate. Tech Hand Up Extrem Surg 2012; 16 (04) 236-241
    CrossrefPubMedGoogle Scholar
  • 46 Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 1995; 35 (01) 54-59
    CrossrefPubMedGoogle Scholar
  • 47 Tchurukdichian A. A. Scaphoïdectomie et arthrodèse de « 4os » par cupule X-Podeeasy-lock system: technique opératoire, premiers résultats et revue dela littérature. . In: Herzberg G, editor. Arthrose péri-scaphoïdienne. Montpellier: Sauramps Médical; 2006. 199–213
    PubMedGoogle Scholar
  • 48 Roux JL. Intérêt de l’ostéosynthèse par plaque dans l’arthrodèse des quatre osinternes pour collapsus arthrosique du carpe. . In: Herzberg G, editor. Arthrosepéri-scaphoïdienne. Montpellier: Sauramps Médical; 2006. 215–228
    PubMedGoogle Scholar
  • 49 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (01) 94-104
    CrossrefPubMedGoogle Scholar
  • 50 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (05) 719-725
    CrossrefPubMedGoogle Scholar
  • 51 Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am 1994; 19 (05) 751-759
    CrossrefPubMedGoogle Scholar
  • 52 Kraisarin J, Dennison DG, Berglund LJ, An KN, Shin AY. Biomechanical comparison of three fixation techniques used for four-corner arthrodesis. J Hand Surg Eur Vol 2011; 36 (07) 560-567
    CrossrefPubMedGoogle Scholar
  • 53 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 (02) 433-442
    CrossrefPubMedGoogle Scholar
  • 54 Gohritz A, Gohla T, Stutz N. et al. Special aspects of wrist arthritis management for SLAC and SNAC wrists using midcarpal arthrodesis: results of bilateral operations and conversion to total arthrodesis. Bull Hosp Jt Dis 2005; 63 (1-2): 41-48
    PubMedGoogle Scholar
  • 55 Skie MC, Gove N, Ciocanel DE, Smith H. Management of non-united four-corner fusions. Hand (N Y) 2007; 2 (01) 34-38
    CrossrefPubMedGoogle Scholar
  • 56 Schulze-Tanzil G. Activation and dedifferentiation of chondrocytes: implications in cartilage injury and repair. Ann Anat 2009; 191 (04) 325-338
    CrossrefPubMedGoogle Scholar
  • 57 Dell'accio F, Vincent TL. Joint surface defects: clinical course and cellular response in spontaneous and experimental lesions. Eur Cell Mater 2010; 20: 210-217
    CrossrefPubMedGoogle Scholar
  • 58 Ball B, Bergman JW. Scaphoid excision and 4-corner fusion using retrograde headless compression screws. Tech Hand Up Extrem Surg 2012; 16 (04) 204-209
    CrossrefPubMedGoogle Scholar
  • 59 Ho PC. Arthroscopic partial wrist fusion. Tech Hand Up Extrem Surg 2008; 12 (04) 242-265
    CrossrefPubMedGoogle Scholar
  • 60 Lluch A, Salvá G, Esplugas M, Llusá M, Hagert E, Garcia-Elias M. El papel de la propiocepción y el control neuromuscular en las inestabilidades del carpo. Rev Iberoam Cir Mano 2015; 43 (01) 70-78
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 61 Kitzinger HB, Karle B, Prommersberger KJ, van Schoonhoven J, Frey M. Four-corner arthrodesis–does the source of graft affect bony union rate? Iliac crest versus distal radius bone graft. J Plast Reconstr Aesthet Surg 2012; 65 (03) 379-383
    CrossrefPubMedGoogle Scholar
  • 62 Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 2007; 28 (32) 4845-4869
    CrossrefPubMedGoogle Scholar
  • 63 Pokorný D, Fulín P, Slouf M, Jahoda D, Landor I, Sosna A. [Polyetheretherketone (PEEK). Part II: application in clinical practice]. Acta Chir Orthop Traumatol Cech 2010; 77 (06) 470-478
    CrossrefPubMedGoogle Scholar
  • 64 Rodgers JA, Holt G, Finnerty EP, Miller B. Scaphoid excision and limited wrist fusion: a comparison of K-wire and circular plate fixation. Hand (N Y) 2008; 3 (03) 276-281
    CrossrefPubMedGoogle Scholar
  • 65 Luegmair M, Houvet P. Effectiveness of four-corner arthrodesis with use of a locked dorsal circular plate. Clin Orthop Relat Res 2012; 470 (10) 2764-2770
    CrossrefPubMedGoogle Scholar
  • 66 del Piñal F, Klausmeyer M, Thams C, Moraleda E, Galindo C. Early experience with (dry) arthroscopic 4-corner arthrodesis: from a 4-hour operation to a tourniquet time. J Hand Surg Am 2012; 37 (11) 2389-2399
    CrossrefPubMedGoogle Scholar
  • 67 del Piñal F, Tandioy-Delgado F. (Dry) arthroscopic partial wrist arthrodesis: tips and tricks. Handchir Mikrochir Plast Chir 2014; 46 (05) 300-306
    Artikel in Thieme ConnectPubMedGoogle Scholar