scholarly journals Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study

2021 ◽  
Vol 49 (02) ◽  
pp. e105-e114
Author(s):  
Francisco R. Melibosky ◽  
Rene A. Jorquera ◽  
Felipe Z. Saxton ◽  
Pablo Orellana ◽  
Diego Junqueras ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Comparative Study ◽  
Range Of Motion ◽  
Circular Plate ◽  
Locking Plate ◽  
Plate Versus ◽  
Fixation Method ◽  
Union Rate ◽  
Non Union ◽  
Headless Compression Screws

Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.

Four-Corner Fusion: A Retrospective Comparative Study of Fixation with a Circular Plate versus Compression Screws

2009 ◽  
Vol 34 (7) ◽  
pp. 11
Author(s):  
Harris S. Rose ◽  
Jeffrey B. Friedrich ◽  
Michael T. Mulligan ◽  
Thanapong B. Waitayawinyu ◽  
Thomas E. Trumble
Keyword(s):  
Comparative Study ◽  
Circular Plate ◽  
Plate Versus ◽  
Retrospective Comparative Study

scholarly journals First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation

2015 ◽  
Vol 9 (1) ◽  
pp. 480-482 ◽  
Author(s):  
M.A Rashid ◽  
M Parnell ◽  
W.S Khan ◽  
A Khan
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Fixation Method ◽  
Compression Screw ◽  
Clinical Criteria ◽  
Non Union ◽  
Lag Screw ◽  
Retrospective Comparison ◽  
Significant Difference ◽  
Interfragmentary Compression

First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.

scholarly journals Comparison of clinic-radiological and functional outcome of intra articular distal end radius fractures managed by volar locking plate versus external fixation

2021 ◽  
Vol 9 (8) ◽  
pp. 2324
Author(s):  
Pankaj Vir Singh ◽  
Gagandeep Singh ◽  
Tejpal Singh ◽  
Abdul Ghani ◽  
Zubair A. Lone
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
External Fixator ◽  
Locking Plate ◽  
Plate Versus ◽  
Dash Score ◽  
Volar Locking Plate ◽  
Radius Fractures ◽  
Medical College ◽  
Articular Fractures

Background: Distal end radius (DER) fractures are most common fractures in upper limb. Intra articular fractures can be managed either by open reduction and internal fixation by volar locking plate or can be managed by closed reduction and external fixator application or by percutaneous pinning. The purpose of our study was to compare the functional outcome of volar locking plate with that of external fixation.Methods: A prospective cohort study was conducted between June 2019 to June 2020 in Government Medical College, Jammu on 46 patients with intra articular distal end radius fractures. Of which 26 were managed by volar locking plate and 20 were managed by external fixator. the results of both groups were compared on the basis of radiological parameter and range of motion achieved post operatively. The functional outcome was evaluated using DASH score and Gartland–Werley scale. Results: Final range of motion, grip strength were better in patients managed with volar locking plate (VLP) as compared to those who were managed with external fixator (EF). Radiographically, volar tilt, radial height were all better in VLP group than EF.Conclusions: We concluded that VLP is superior method to maintain reduction till the union occurs and prevents the fracture collapse in intra articular distal end radius fractures as compared with external fixator. Thus, giving better functional and radiological outcome than the external fixator.

Four-Corner Arthrodesis Using a Dedicated Dorsal Circular Plate

Hand ◽  
2020 ◽  
pp. 155894472094823
Author(s):  
Massimo Corain ◽  
Roberta Sartore ◽  
Mara Laterza ◽  
Filippo Zanotti ◽  
Paolo Pozza ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Circular Plate ◽  
Locking Plate ◽  
Standard Procedure ◽  
Complete Fusion ◽  
Scaphoid Nonunion ◽  
Carpal Collapse ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

Background: Scaphoid excision and 4-corner fusion is a standard procedure for advanced carpal collapse. The purpose of this study was to evaluate its effectiveness using a specific designed locking plate of the latest generation. Methods: Between October 2012 and December 2015, 12 patients underwent this procedure using the Flower (KLS Martin Group, Tuttlingen, Germany) circular locking plate. The surgical technique is standardized. Three patients were affected by a scapholunate advanced collapse and 9 patients by a scaphoid nonunion advanced collapse. All patients underwent a computed tomographic scan to study the real achievement of the fusion. Results: Only 2 patients did not show complete fusion. All the patients with successful fusion returned to previous work and manual activities. Conclusions: Four-corner arthrodesis with circular locking plate is an alternative surgical treatment for carpal arthritic collapse.

scholarly journals Comparative study of operative treatment of mid shaft fracture of humerus by locking plate versus intramedullary interlocking nail

2013 ◽  
Vol 6 (4) ◽  
pp. 390 ◽  
Author(s):  
Arunima Chaudhuri ◽  
Sudipta Dasgupta ◽  
Soma Datta ◽  
Soumya Ghosh ◽  
TarakChandra Halder ◽  
...  
Keyword(s):  
Comparative Study ◽  
Operative Treatment ◽  
Locking Plate ◽  
Shaft Fracture ◽  
Plate Versus ◽  
Interlocking Nail

scholarly journals Retrospective Analysis of Non-Union Rate Associated with Immediate Weightbearing Following A Modified Lapidus Arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Type Ii Diabetes ◽  
Locking Plate ◽  
Weight Bearing ◽  
Type Ii Diabetes Mellitus ◽  
Inclusion Criteria ◽  
Union Rate ◽  
Early Weight Bearing ◽  
Non Union ◽  
Ankle Motion ◽  
Post Operative Period

Category: Bunion Introduction/Purpose: A 6-8 week non-weightbearing period post modified lapidus arthrodesis has traditionally been universally accepted. A review of the literature reports nonunion rates between 5-33% after modified lapidus with 6-8 weeks of non- weightbearing. There are only a few reports in the literature that discuss immediate weightbearing after the modified lapidus procedure. In this retrospective review, we examine the nonunion rate among patients undergoing the modified lapidus arthrodesis who were immediately weightbearing in a controlled ankle motion (CAM) boot. It is our hypothesis that the non- union rate will be comparable to the traditional post-operative protocol nonunion rate. Methods: In this retrospective study, we evaluated chart data on patients who underwent a modified Lapidus arthrodesis with immediate weight- bearing in a CAM boot. The goal of the study was to determine if a modified Lapidus surgical technique in conjunction with rigid internal fixation produces the necessary stability post-operatively in order to allow bony consolidation while being stressed with immediate weight bearing forces. Patients who underwent a modified Lapidus arthrodesis using either a 3 screw construct or a medially placed locking plate with an interfragmentary screw were included in the study. Patients with other adjunctive procedures that would prevent early weight bearing were not included in the investigation. Results: A total of 376 patients were identified with 74 patients meeting inclusion criteria. 4 patients had bilateral procedures performed at separate times for a total of 78 Lapidus procedures. 31 patients had a 3 screw construct while 43 patients had a medial locking plate with an interfragmentary screw. 15 patients admitted to using nicotine. Additionally, 7 patients had type II Diabetes Mellitus. Autogenous shear- strain relief bone graft was used in 75 of the 79 procedures.Three patients (3.8%) experienced a post-operative non-union. Interestingly, none of the patients with non-unions were smokers and only one patient was diabetic. Conclusion: The results of this study found a 3.8% nonunion rate. Based on these results we conclude that a modified Lapidus procedure using a long, solid interfragmentary screw with either additional screw support or a locking plate, we may permit patients to ambulate safely in a CAM boot immediately post- operative period without affecting surgical outcome.

OUTCOMES OF FOUR-CORNER ARTHRODESIS USING THE HUBCAPTM CIRCULAR PLATE

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 215-220 ◽  
Author(s):  
Sameer K. Khan ◽  
Syed M. Ali ◽  
Andrew McKee ◽  
Jonathan W. M. Jones
Keyword(s):  
Range Of Motion ◽  
Circular Plate ◽  
Functional Outcomes ◽  
Circular Plates ◽  
Ulnar Deviation ◽  
Non Union ◽  
Flexion Extension ◽  
Radiological Union

We present results of four-corner carpal arthrodesis with the Acumed® HubcapTM circular plate performed at our unit. Eight patients underwent eight procedures over five years, for scapholunate advanced collapse (five wrists) and scaphoid non-union advanced collapse (three wrists). Outcomes included range of motion, quickDASH scores, and visual analogue scores for satisfaction. At final follow-up, mean flexion-extension arc was 56°, mean radial-ulnar deviation 29° and mean quickDASH score was 23/100. Mean score for satisfaction was 7.7/10 (77%). Seven out of eight (87.5%) patients said they would have it done again, and would also recommend it to others. Radiological union was achieved in all cases. One screw broke in one arthrodesis without causing symptoms. The functional outcomes with our use of the HubcapTM are comparable to those reported in literature to date with other circular plates (e.g. Spider plate). There were no non-unions, which is the main reported complication with these plates.

Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation

2014 ◽  
Vol 40 (4) ◽  
pp. 351-355 ◽  
Author(s):  
H. P. Singh ◽  
C. Hoare ◽  
N. Beresford-Cleary ◽  
R. Anakwe ◽  
M. Hayton
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Senior Author ◽  
Union Rate ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Wire Fixation ◽  
Headless Compression Screws ◽  
K Wires

We reviewed 63 trapeziometacarpal arthrodeses (57 patients) performed in our unit between April 2007 and May 2013 for osteoarthritis. K-wires, plates, headless compression screws and memory staples were used for fixation. The average age of patients was 50 (range 20–78) years and there were 36 men and 21 women with a mean follow-up of 36 (range 6–62) months. K-wires were used in 31 cases, staples in 12, plates in five, and screws in 15 joints. The overall non-union rate was 11%, however, when using K-wires for fixation, it was 20%. Union was achieved in all cases when staples or screws were used for fixation. Disabilities of the Arm, Shoulder and Hand scores were higher in cases where non-union occurred compared with those that united (66.7 vs. 21.9). Trapeziometacarpal arthrodesis for osteoarthritis gives good clinical outcome with lower (DASH) scores when union occurs. K-wire fixation led to a 20% non-union rate, and as a result, the senior author no longer uses this method of fixation.

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