J Wrist Surg 2023; 12(03): 225-231
DOI: 10.1055/s-0042-1757448
Scientific Article

Four-Corner Arthrodesis with a Dorsal Locking PEEK Plate: A Retrospective Case Series

1   Division of Orthopedic Surgery, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
,
2   Department of Medical Imaging, Saskatchewan Health Authority, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
2   Department of Medical Imaging, Saskatchewan Health Authority, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
,
David A. Sauder
3   Division of Orthopedic Surgery, Royal University Hospital, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
4   Saskatoon Orthopedic and Sports Medicine Center, Saskatoon, Saskatchewan, Canada
› Institutsangaben
Funding Funding for this study was provided by the University of Saskatchewan College of Medicine Dean's Research Project Bursary. The funding source did not have any involvement in the study design, data collection, or writing of the manuscript.

Abstract

Background Four-corner arthrodesis (4CA) can be performed with a variety of methods. To our knowledge, fewer than 125 cases of 4CA with a locking polyether ether ketone (PEEK) plate have been reported, necessitating further study.

Purpose The purpose of this study was to evaluate the radiographic union rate and clinical outcomes in a series of patients who received 4CA with a locking PEEK plate.

Methods We re-examined 39 wrists in 37 patients at a mean follow-up of 50 months (median: 52 months, range: 6–128). Patients completed the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), and participated in measurements of grip strength and range of motion. Anteroposterior, lateral, and oblique radiographs of the operative wrist were examined for union, screw breakage and/or loosening, and lunate change.

Results The mean QuickDASH score was 24.4 and the mean PRWE score was 26.5. Mean grip strength was 29.2 kg or 84% of the nonoperative hand. Mean flexion, extension, radial deviation, and ulnar deviation were : 37.2, 28.9, 14.1, and 17.4 degrees, respectively. Eighty-seven percent of wrists achieved union; 8% had nonunion; and5% had indeterminate union. There were seven cases of screw breakage and seven cases of screw loosening (as defined by lucency or bony resorption surrounding screws). Twenty-three percent of wrists required reoperation (four total wrist arthrodesis and five reoperations for other reasons).

Conclusion 4CA with a locking PEEK plate has clinical and radiographic outcomes similar to other methods. We observed a high rate of hardware complications. It is unclear whether this implant offers a clear advantage over other methods of fixation used in 4CA.

Type of Study/Level of Evidence Level IV, therapeutic study.

Ethical Review

This study was approved by the University of Saskatchewan Biomedical Research Ethics Board (Bio-REB) in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans.




Publikationsverlauf

Eingereicht: 28. September 2021

Angenommen: 17. August 2022

Artikel online veröffentlicht:
13. Oktober 2022

© 2022. Thieme. All rights reserved.

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

 
  • References

  • 1 Watson HK, Goodman ML, Johnson TR. Limited wrist arthrodesis. Part II: intercarpal and radiocarpal combinations. J Hand Surg Am 1981; 6 (03) 223-233
  • 2 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
  • 3 Le Corre A, Ardouin L, Loubersac T, Gaisne E, Bellemère P. Retrospective study of two fixation methods for 4-corner fusion: shape-memory staple vs. dorsal circular plate. Chir Main 2015; 34 (06) 300-306
  • 4 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
  • 5 Rhee PC, Shin AY. The rate of successful four-corner arthrodesis with a locking, dorsal circular polyether-ether-ketone (PEEK-Optima) plate. J Hand Surg Eur Vol 2013; 38 (07) 767-773
  • 6 Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg [Br] 1999; 24 (03) 307-315
  • 7 Tielemans A, Van Innis F, Troussel S, Detrembleur C, Libouton X, Lequint T. Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: new treatment guidelines. Hand Surg Rehabil 2017; 36 (03) 186-191
  • 8 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
  • 9 Kani KK, Mulcahy H, Porrino J, Aaron D, Chew FS. Update on the operative treatment of scapholunate instability for radiologists. II. Salvage procedures, total wrist arthrodesis, and total wrist arthroplasty. Skeletal Radiol 2017; 46 (08) 1031-1040
  • 10 Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 2007; 28 (32) 4845-4869
  • 11 Rudnick B, Goljan P, Pruzansky JS, Bachoura A, Jacoby SM, Rekant MS. Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes. Hand (N Y) 2014; 9 (03) 315-321
  • 12 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
  • 13 Rimokh J, Benazech B, Lebeau N, Haddad B, Moughabghab M, David E. Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four-corner arthrodesis with locking plate. Hand Surg Rehabil 2020; 39 (01) 36-40
  • 14 Wagner ER, Werthel JD, Elhassan BT, Moran SL. Proximal row carpectomy and 4-corner arthrodesis in patients younger than age 45 years. J Hand Surg Am 2017; 42 (06) 428-435
  • 15 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457
  • 16 Shin AY. Surgical Technique Guide for 4-Corner Fusion. Accessed January 6, 2020; at: https://www.trimedortho.com/wp-content/uploads/2018/05/209-19-141112-WP-4CornerFusionSHIN.pdf
  • 17 Beaton DE, Wright JG, Katz JN. Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
  • 18 MacDermid JC. Development of a scale for patient rating of wrist pain and disability. J Hand Ther 1996; 9 (02) 178-183
  • 19 Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10 (01) 39-46
  • 20 Reissner L, Hensler S, Kluge S, Marks M, Herren DB. Treatment outcomes of 4-corner arthrodesis for patients with advanced carpal collapse: an average of 4 years' follow-up comparing 2 different plate types. J Hand Surg Am 2018; 43 (05) 487.e1-487.e6