Management of non-united four-corner fusions.
OBJECTIVE
Wrist degeneration, resulting from scaphoid nonunion or scapholunate ligamentous disruption, is widely managed with scaphoid excision with four-corner fusion. There are no specific details in the literature regarding "salvage" of nonunion after attempted "four-corner fusions" or the patient outcomes. The purpose of this paper is to present the results of patients who underwent treatment for nonunion after four-corner fusion, the subsequent surgeries done for wrist salvage and the functional results.


METHODS
We reviewed, retrospectively, 37 patients who underwent limited wrist fusion using circular plate fixation, of which eight cases (22%) went on to nonunion and necessitated revision surgeries with plate exchange and bone graft. (Table 1) Five of eight patients were available to return to the clinic, and the wrist range of motion and the disabilities of the arm, shoulder, and hand (DASH) score were recorded.


RESULTS
The average DASH score was 46 (range, 15 to 60.8). Grip on the affected limb was, on the average, 62% of the contralateral limb. Average arc of wrist motion was 70 degrees (35.7 degrees of flexion and 34.3 degrees of extension). Three of the five patients were laborers, and two returned to the previous employment. The remaining two patients returned to their previous sedentary jobs. All patients reported difficulty with recreational activities involving heavy activity.


CONCLUSIONS
Complications of four-corner arthrodesis using circular plate fixation were recorded, revealing a high number of nonunions and hardware failures. All nonunions were salvaged with allograft or autogenous grafting with plate revision; however, the patients did have considerable limitations.
Skie
Martin C
MC
Department of Orthopaedic Surgery, University of Toledo-Health Science Campus, 3065 Arlington Ave, Dowling Hall, Toledo, Ohio, 43614, USA.
Gove
Nicholas
N
Ciocanel
Despina E
DE
Smith
Holly
H
J Hand Surg Am. 2005 Sep;30(5):903-7
16182043
Handchir Mikrochir Plast Chir. 2005 Apr;37(2):119-25
15877273
Unfallchirurg. 2000 Jul;103(7):564-71
10969544
J Hand Surg Am. 2005 Nov;30(6):1122-7
16344166
Handchir Mikrochir Plast Chir. 2003 Oct;35(5):304-9
14577045
J Hand Surg Br. 1999 Jun;24(3):307-15
10433444
J Hand Surg Am. 1999 Jan;24(1):133-7
10048527
J Hand Surg Am. 1995 Nov;20(6):965-70
8583069
Ann Plast Surg. 2006 Feb;56(2):139-44
16432320
J Hand Surg Am. 1984 May;9(3):358-65
6725894
Bull Hosp Jt Dis. 2005;63(1-2):41-8
16536218
Handchir Mikrochir Plast Chir. 2000 Nov;32(6):369-74
11189889
J Hand Surg Am. 1994 Sep;19(5):751-9
7806795
Handchir Mikrochir Plast Chir. 2001 Nov;33(6):408-17
11917679
J Hand Surg Am. 1996 Jul;21(4):717-23
8842977
J Hand Surg Am. 1994 Sep;19(5):741-50
7806794
Hand Clin. 2005 Nov;21(4):531-8
16274862
J Hand Surg Br. 2000 Aug;25(4):341-5
11058000
J Hand Surg Am. 2001 Jan;26(1):94-104
11172374
J Hand Surg Am. 1994 Jan;19(1):134-42
8169358