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J Wrist Surg
DOI: 10.1055/s-0044-1786027
Survey or Meta-Analysis

Midcarpal Arthrodesis with or without Excision of Triquetrum: A Systematic Review

Richard Tee
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia
,
J. R. Onggo
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia
,
Nicola F. Fine
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia
,
Stephen K. Tham
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia
3   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, VIC, Australia
,
Eugene T. Ek 
1   Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash Health, Melbourne, VIC, Australia
2   Melbourne Orthopaedic Group, Windsor, VIC, Australia
3   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Fitzroy, VIC, Australia
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Abstract

Purpose The purpose of this systematic review is to compare the clinical outcomes of midcarpal arthrodesis with triquetrum excision against midcarpal fusion without the excision of triquetrum performed using modern osteosynthesis technology.

Methods A systematic review of publications in PubMed, Medline, EMBASE, and Cochrane Database of Systematic Review was conducted. The studies that utilized osteosynthesis techniques other than Kirshner wire, with at least 10 patients, and had a minimum one-year follow-up period in English language were included. The quality of studies were evaluated using validated tools for assessing observational studies. Union rate, functional outcomes and revision/complication rates were collected and analyzed.

Results A meta-analysis was not possible. Based on pooled data the flexion-extension arc improved by 6 degrees for midcarpal arthrodesis group with triquetrum excision, but decreased by 11 degrees in the group without. The radial-ulnar arc improved by 5 degrees in the triquetrum excision group, but decreased by 3 degrees in the triquetrum preserving group. Improvement in grip strength appears to be better in the triquetrum preserving group (10 kg as opposed to 1 kg), while there were no observable difference in pain score.

Conclusions The literature lacked good comparison studies to examine the role of triquetrum excision in midcarpal fusion. While midcarpal fusion with triquetrum excision appeared to yield better ROM in the pooled data, studies with direct comparison of the two techniques are required to fill in the gap.

Type of Study/Level of Evidence Therapeutic IV.

Keywords

two-corner fusion - capitolunate arthrodesis - three-corner arthrodesis - four corner arthrodesis - triquetrum excision

Location Work Conducted

All work was conducted at Dandenong Hospital, Monash Health, Victoria, Australia.


Supplementary Material



Publication History

Received: 22 January 2024

Accepted: 21 March 2024

Article published online:
26 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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