Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist

Traverso, P; Wong, Anselm; Wollstein, Ronit; Carlson, Lois; Ashmead, Duffield; Hk, Watson

doi:10.1177/1558944716681949

Cited by 46 publications

(30 citation statements)

References 25 publications

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“…1,6,7,12 El gold standard para la artrodesis de 4 esquinas es la cirugía abierta, en donde la configuración de tornillos para la fijación de los huesos del carpo más usada es la bicolumnar, con un tornillo entre semilunar-capitato y otro tornillo entre triquetral-hamato. 4,8,9 Durante los últimos años, esa técnica quirúrgica se ha estado realizando en forma percutánea con asistencia artroscópica con buenos resultados en algunas publicaciones, 6,7 en donde los autores describen algunas ventajas por sobre la técnica abierta dadas por el menor daño a tejidos, al ser una técnica mínimamente invasiva, mayor protección del aporte sanguíneo, preservación de la propiocepción y mejores resultados estáticos. 6,7 En el presente trabajo se muestra la técnica quirúrgica realizada mediante cirugía abierta y la realizada en forma mínimamente invasiva con asistencia artroscópica con buenos resultados para ambas técnicas.…”

Section: Discussionunclassified

Artrodesis de cuatro esquinas: Análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica

Cifras

Azócar

Bernal

et al. 2021

Revista Chilena de Ortopedia y Traumatología

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Resumen Introducción La artrodesis de cuatro esquinas es una técnica de salvataje para los pacientes con artrosis avanzada del carpo. Los objetivos quirúrgicos son disminuir el dolor y mantener cierto movimiento de la muñeca. En el último tiempo, se han descrito técnicas percutáneas con asistencia artroscópica que han logrado resultados favorables, a pesar de que la técnica abierta sigue siendo el gold estándar para realizar esa técnica quirúrgica. Objetivo Comparar resultados funcionales y radiológicos en pacientes con muñecas con colapso avanzado escafolunar (scapholunate advanced collapse, SLAC) o colapso avanzado en la pseudoartrosis del escafoides (scaphoid nonunion advanced collapse, SNAC) operados con técnica quirúrgica abierta versus técnica percutánea con asistencia artroscópica. Materiales y Métodos Estudio retrospectivo tipo caso-control, de fichas clínicas e imagenología de pacientes con artrosis avanzada del carpo operados con técnica percutánea y asistencia artroscópica y cirugía abierta. Se estudian variables demográficas, dolor mediante la Escala Visual Analógica (EVA), función en rangos de movilidad, tiempo de consolidación, y corrección del ángulo capitolunar. Se describe la técnica quirúrgica de la cirugía abierta y la cirugía percutánea con asistencia artroscópica. Resultados Se estudiaron 22 pacientes del sexo masculino con edad promedio de 32,5 años. Había 13 pacientes en el grupo de casos (técnica percutánea con asistencia artroscópica) y 9 pacientes en el grupo de controles (técnica abierta). El dolor en la EVA al momento del egreso hospitalario fue de 3 para los casos y de 5 para los controles (p = 0,008), y a los 30 días del postoperatorio, fue de 0 y 3 respectivamente (p = 0,00). Los rangos de extensión y flexión fueron de 52,6° y 38,7° para los casos y de 35,7° y 32,4° para los controles (p = 0,1119 y 0,0016, respectivamente). El ángulo capitolunar fue de 10° para los controles y de 5° para los casos (p = 0,0008). El tiempo de consolidación fue de 8,8 semanas para los casos y de 12,5 semanas para los controles (p = 0,039). Discusión Tanto la técnica percutánea con asistencia artroscópica cuanto la cirugía abierta para realizar una artrodesis de cuatro esquinas son técnicas reproducibles y efectivas en lograr consolidación, disminución del dolor, y mantenimiento de rangos de movimiento en la muñeca. Conclusión En el presente trabajo se demuestran mejores promedios de los parámetros evaluados con la técnica percutánea que con la cirugía abierta; sin embargo, es necesario realizar estudios prospectivos para realizar una recomendación con respecto a la técnica quirúrgica de elección.

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Section: Discussionunclassified

Artrodesis de cuatro esquinas: Análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica

Cifras

Azócar

Bernal

et al. 2021

Revista Chilena de Ortopedia y Traumatología

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“…At an average follow-up of 18 years, Traverso et al. described high rates of functional wrists according to the DASH score and with about 50% of normal wrist flexion–extension (Traverso et al., 2017). Likewise, Neubrech et al.…”

Section: Discussionmentioning

confidence: 99%

Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis

Ferrero¹,

Summa

Giacalone³

et al. 2020

J Hand Surg Eur Vol

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In this retrospective study we report on two comparable groups of patients with advanced carpal arthritis treated with either proximal row carpectomy combined with a pyrocarbon resurfacing of the capitate (31 patients) or a four-corner arthrodesis and dorsal plating (26 patients). Follow-up time was 46 months (24–118). Except for a modestly higher radial wrist deviation in the patients treated with four-corner arthrodesis, there were no significant differences in outcomes between the groups. Asymptomatic progression of osteoarthritis in the lunate fossa was observed in four cases in both groups. Two cases were converted to a total wrist arthrodesis in the pyrocarbon group compared with one case in the four-corner arthrodesis group. Although four-corner arthrodesis remains the reference standard in the treatment of wrist osteoarthritis with involvement of the midcarpal joint, proximal row carpectomy combined with pyrocarbon resurfacing of the capitate is an alternative option. It can even be used in selected cases with erosion of the lunate fossa. Level of evidence: III

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“…Two systematic reviews of PRC and FCA outcomes did not identify any differences in patient-reported disability, subjective ratings of satisfaction, rate of conversion to total wrist arthrodesis, or increase in grip strength 7 , 8 . Despite these findings and reports that both PRC and FCA can be associated with the development of radiographic evidence of arthrosis at long-term follow-up 6 , 23 , some authors have stated that FCA may provide a more desirable result 6 , 24 - 27 . It is clear that controversy exists with regard to which surgery yields a superior clinical result.…”

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confidence: 97%

“…For patients with Stage-I or II scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) arthritis for whom motion-sparing surgery is indicated, the optimal treatment remains unclear 3 and has traditionally included either proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) 4 , 5 . Because SLAC arthritis is the most common form of wrist degenerative arthritis 6 , defining the optimal surgical treatment would be an important step in improving patient outcomes while minimizing costs.…”

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confidence: 99%

“…Clinical outcomes, or health states or utilities, are integral in determining the cost-effectiveness of a given treatment. Numerous studies have assessed the clinical outcomes of PRC and FCA 3 , 6 - 22 . Two systematic reviews of PRC and FCA outcomes did not identify any differences in patient-reported disability, subjective ratings of satisfaction, rate of conversion to total wrist arthrodesis, or increase in grip strength 7 , 8 .…”

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Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

et al. 2020

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Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform clinical decision-makers, we conducted a cost-effectiveness analysis comparing proximal row carpectomy (PRC) and four-corner arthrodesis (FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs, and health utilities between PRC and FCA. The model used a 10-year time horizon and a 1-month cycle length, and it was evaluated from the societal perspective. Utilities and clinical parameters including transition probabilities for debridement for infection, removal of implants, conversion to total wrist arthrodesis, revision FCA, and revision total wrist arthrodesis were obtained from published literature. Timing of complications was estimated from the literature. Direct medical costs were derived from Medicare ambulatory surgical cost data, and indirect costs for missed work due to surgical procedures and complications were included. The effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic sensitivity analysis and 1-way threshold analysis for utilities were performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and greater effectiveness). The mean (and standard deviation) for the total cost and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28, respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26, respectively, for FCA. In the probabilistic sensitivity analysis, PRC dominated FCA in 57% of the 1 million iterations. The cost-effectiveness acceptability curve indicated that PRC is the most cost-effective strategy regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic sensitivity analysis. These results suggest that PRC is the optimal strategy for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV . See Instructions for Authors for a complete description of levels of evidence.

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Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist

Abstract: Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.

Cited by 46 publications

References 25 publications

Artrodesis de cuatro esquinas: Análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica

Artrodesis de cuatro esquinas: Análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica

Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis

Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis

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