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Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis.
J Hand Surg Am. 2009 Oct; 34(8):1407-12.JH

Abstract

PURPOSE

To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthrodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis.

METHODS

We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strength; visual analog scale (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthroplasty, and pisotriquetral arthritis were recorded.

RESULTS

Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strength, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision.

CONCLUSIONS

Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strength, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the lunate following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concern with this technique.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic III.

Authors+Show Affiliations

OrthoCarolina, Charlotte, NC 28204, USA. glenngaston@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19733983

Citation

Gaston, R Glenn, et al. "Clinical Outcomes of Scaphoid and Triquetral Excision With Capitolunate Arthrodesis Versus Scaphoid Excision and Four-corner Arthrodesis." The Journal of Hand Surgery, vol. 34, no. 8, 2009, pp. 1407-12.
Gaston RG, Greenberg JA, Baltera RM, et al. Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am. 2009;34(8):1407-12.
Gaston, R. G., Greenberg, J. A., Baltera, R. M., Mih, A., & Hastings, H. (2009). Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. The Journal of Hand Surgery, 34(8), 1407-12. https://doi.org/10.1016/j.jhsa.2009.05.018
Gaston RG, et al. Clinical Outcomes of Scaphoid and Triquetral Excision With Capitolunate Arthrodesis Versus Scaphoid Excision and Four-corner Arthrodesis. J Hand Surg Am. 2009;34(8):1407-12. PubMed PMID: 19733983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. AU - Gaston,R Glenn, AU - Greenberg,Jeffrey A, AU - Baltera,Robert M, AU - Mih,Alex, AU - Hastings,Hill, Y1 - 2009/09/06/ PY - 2007/12/01/received PY - 2009/05/20/revised PY - 2009/05/27/accepted PY - 2009/9/8/entrez PY - 2009/9/8/pubmed PY - 2009/12/31/medline SP - 1407 EP - 12 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 34 IS - 8 N2 - PURPOSE: To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthrodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis. METHODS: We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strength; visual analog scale (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthroplasty, and pisotriquetral arthritis were recorded. RESULTS: Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strength, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision. CONCLUSIONS: Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strength, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the lunate following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concern with this technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/19733983/Clinical_outcomes_of_scaphoid_and_triquetral_excision_with_capitolunate_arthrodesis_versus_scaphoid_excision_and_four_corner_arthrodesis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0363-5023(09)00453-5 DB - PRIME DP - Unbound Medicine ER -