title: Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study.
abstract: BACKGROUND
  Four-corner fusion was described in 1984 by HK Watson for the treatment of SLAC wrist. This intervention has undergone few changes since that description, but the debate on the fixation method is still not resolved.
  
  
  OBJECTIVE
  Dorsal locking plates provide better stability, short immobilization and a quicker return to daily activities than traditional fixation methods such as staples.
  
  
  METHODS
  Thirty-one fusions using the Medartis Aptus Four-Corner Fusion(®) plate at a mean 13.1 months' follow-up and 35 using staples at a mean 80.4 months' follow-up were reviewed in a clinical and radiographic retrospective comparative study.
  
  
  RESULTS
  Results were comparable between the two groups in terms of range of motion (flexion-extension arc of 67.3° for plates and 60.6° for staples), force (29.6 and 28 kg.F), pain and disability (PRWE 34.8/150 and 40.9; QuickDASH 19.83/100 and 30). Mean time off work was significantly shorter in the plate group (4.5 vs. 7.9 months). There were no non-unions in the plate group, versus 2 in the staples group. Dorsal impingement implicating hardware was also less frequent in the plate group (2 vs. 11).
  
  
  CONCLUSIONS
  The dorsal locking plate did not improve final results in four-corner fusion in terms of range of motion, force, pain or function compared to staples. However, it provided stable fixation, allowing a shorter immobilization and a quicker return to work. Although the initial cost is higher, it could allow significant savings on postoperative costs, shifting the technical debate into the field of public health.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France. Electronic address: pauchard.nicolas@neuf.fr.
authors.forename: N
authors.initials: N
authors.lastname: Pauchard
authors.affiliation: Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France.
authors.forename: C
authors.initials: C
authors.lastname: Lecoanet-Strugarek
authors.affiliation: SOS Mains, Orléans-Val-de-Loire, France.
authors.forename: J
authors.initials: J
authors.lastname: Segret
authors.affiliation: DIM, Centre Chirurgical Émile-Gallé, Nancy, France.
authors.forename: M
authors.initials: M
authors.lastname: De Gasperi
authors.affiliation: Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France.
authors.forename: F
authors.initials: F
authors.lastname: Dap
authors.affiliation: Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France.
authors.forename: G
authors.initials: G
authors.lastname: Dautel
mesh_terms: D001174:Arthrodesis / Q000295:instrumentation*; D001860:Bone Plates; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D010147:Pain Measurement; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D062707:Return to Work; D013537:Sutures; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Dorsal locking plate; Four-corner fusion; SLAC wrist; SNAC wrist