Progressing arthrosis and a high conversion rate 11 (4–19) years after four corner fusion. Issue 6 (1st December 2021)

• Record Type: Journal Article
• Authors: Reigstad, Ole; Holm-Glad, Trygve; Dovland, Preben; Korslund, Johanne; Grimsgaard, Christian; Thorkildsen, Rasmus D.; Røkkum, Magne
• Is Part Of: Journal of plastic surgery and hand surgery. Volume 55:Issue 6(2021)
• Page Start: 354
• Page End: 360
• Publication Date: 2021-12-01
• Subjects: SLAC -- SNAC -- wrist degeneration -- wrist arthrosis -- four corner fusion -- limited arthrodesis -- wrist arthrodesis -- wrist arthroplasty; Surgery -- Periodicals; Hand -- Surgery -- Periodicals; Orthopedics -- Periodicals; Surgery, Plastic -- Periodicals; 617.95
• DOI: 10.1080/2000656X.2021.1898970
• Languages: English
• ISSNs: 2000-656X

Abstract

Abstract: Four corner fusion (4CF) is a limited wrist arthrodesis offered to patients with painful wrists due to scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC). A retrospective study of 42 wrists (in 36 patients), operated with 4CF using K-wires and autologous bone graft followed up after 11 (4–19) years was performed, 25 were male and mean age at surgery was 51 (22–71) years. During the follow-up period, 13 wrists were converted to total wrist arthrodesis or wrist arthroplasty, and one is scheduled for conversion (14/42, 33%) due to non-union (3), DISI and progressing arthrosis (7) or progressing arthrosis (4). Non-union was seen in 3/42 (93%) wrists, all were later converted. At the final follow-up, the patients reported residual pain, VAS = 15 and 36 at rest and activity, respectively, and QDASH/PRWHE = 32 and 31, respectively. Active range of motion (AROM) was 38% and grip-strength was 76% compared to the uninjured side. Degenerative changes were seen in 88% on CT scans at follow-up. 4CF renders an acceptable pain reduction and function in the majority of patients, but increased degeneration and a high number of conversions after a longer follow-up time is concerning.