Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Wrist Arthritis Treatment

Background:

• Four-corner arthrodesis is a surgical procedure for treating wrist arthritis, such as scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC).
• Various osteosynthesis methods are employed to achieve bone fusion in this procedure, each with potential implications for outcomes.

Purpose of the Study:

• To systematically compare the union rates and clinical outcomes of four-corner arthrodesis using different osteosynthesis techniques.

Main Methods:

• A systematic review of Ovid, Medline, Embase, and PubMed databases was performed.
• Studies reporting radiographic union rates and clinical outcomes (range of motion, grip strength) for four-corner arthrodesis were included.
• 57 eligible studies were selected from 291 reviewed full texts.

Main Results:

• No significant difference in radiographic union rates was observed among K-wire, screw, staple, nonlocking plate, metal locking plate, and radiolucent locking plate osteosynthesis.
• Fixation method impacted flexion, but pairwise comparisons showed no significant differences.
• Grip strength was significantly lower with metal locking plates compared to K-wires, but other range of motion measures did not differ significantly.

Conclusions:

• All evaluated osteosynthesis methods yield comparable union rates for four-corner arthrodesis.
• While minor differences in range of motion and grip strength exist, they are unlikely to be clinically significant.