9.4 Clinical and CT evaluation of four corner arthrodesis with spider circular plate in the treatment of SLAC/SNAC wrist

Abstract

Introduction: Many of untreated scaphoid non-unions or SL-ligament ruptures lead to SNAC-or SLAC wrist. In SNAC-or SLAC wrist stadium II, PRC or FCF are possible as salvage procedures. If there is already midcarpal arthrosis in stadium III, our option is limited to FCF. Patients and methods: Between July 2000 and December 2004, 64 wrists were treated because of SLAC, SNAC and radiocarpal arthrosis after intraarticular fractures of the distal radius. In 29 cases proximal row carpectomy (PRC) and in 35 cases four corner fusion (FCF) was performed. We could follow up 22 cases of PRC and 28 cases of FCF with a mean follow up of 18.4 (PRC) and 21.6 months (FCF). The mean age of the PRC group was 61, 19 patients were female, 10 male. The mean age of the FCF group was 54, 6 patients were female, 29 male. The following complications were seen: In the PRC group twice a second procedure was necessary; once an arthrodesis of the wrist and once placing a prosthesis. In the FCF group were three complications; one algodystrophy, one infection and one patient needed a second procedure (arthrodesis of the wrist). Results: In all cases significant reduction of extension/ flexion was observed wit a mean range of 681 (PRC) and 701 (FCF). Comparing the grip-strength to the nonoperated hand, we measured 25 compared to 40 kg in the PRC group and 28 compared to 46 kg in the FCF group. The reduction of pain postoperatively was almost the same in both groups. The DASH-score for the FCF group was 32 points after surgery and therefore better than the 36 points for the PRC group. Conclusion: Both procedures are good options as salvage procedures. We prefer PRC for elder patients and women and FCF for younger patients and working men.