Midcarpal Arthrodesis with or without Excision of Triquetrum: A Systematic Review

Purpose  The purpose of this systematic review is to compare the clinical outcomes of midcarpal arthrodesis with triquetrum excision against midcarpal fusion without the excision of triquetrum performed using modern osteosynthesis technology. Materials and Methods  A systematic review of publications in PubMed, Medline, EMBASE, and Cochrane Database of Systematic Review was conducted. The studies that utilized osteosynthesis techniques other than Kirshner wire, with at least 10 patients, and had a minimum one-year follow-up period in English language were included. The quality of studies were evaluated using validated tools for assessing observational studies. Union rate, functional outcomes and revision/complication rates were collected and analyzed. Results  A meta-analysis was not possible. Based on pooled data the flexion-extension arc improved by 6 degrees for midcarpal arthrodesis group with triquetrum excision, but decreased by 11 degrees in the group without. The radial-ulnar arc improved by 5 degrees in the triquetrum excision group, but decreased by 3 degrees in the triquetrum preserving group. Improvement in grip strength appears to be better in the triquetrum preserving group (10 kg as opposed to 1 kg), while there were no observable difference in pain score. Conclusion  The literature lacked good comparison studies to examine the role of triquetrum excision in midcarpal fusion. While midcarpal fusion with triquetrum excision appeared to yield better ROM in the pooled data, studies with direct comparison of the two techniques are required to fill in the gap. Type of Study/Level of Evidence  Therapeutic IV.