Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2022; 13(1): 112-121
Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.112
Long-term outcomes of the four-corner fusion of the wrist: A systematic review
Octavian Andronic, Ladislav Nagy, Marco D Burkhard, Fabio A Casari, Daniel Karczewski, Philipp Kriechling, Andreas Schweizer, Lukas Jud
Octavian Andronic, Ladislav Nagy, Marco D Burkhard, Fabio A Casari, Philipp Kriechling, Andreas Schweizer, Lukas Jud, Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
Daniel Karczewski, Department of Trauma and Orthopaedics, Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin 10117, Germany
Author contributions: Andronic O designed the research methodology and the research question; Jud L managed the research team and wrote the first draft of the manuscript; Burkhard MD, Casari FA, Kriechling P and Karczewski D performed the systematic research and the risk of bias assessment analysis; Nagy L and Schweizer A critically appraised the scientific approach and the final draft of the manuscript; All authors read, edited and approved the final manuscript.
Conflict-of-interest statement: On behalf of all authors, the corresponding author states that there is no conflict of interest.
PRISMA 2009 Checklist statement: The systematic review followed the PRISMA guidelines and included a flowchart for the systematic search.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Octavian Andronic, MD, Doctor, Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Forchstrasse 340, 8008, Zürich, Zürich 8008, Switzerland. octavian.andronic@balgrist.ch
Received: March 29, 2021
Peer-review started: March 29, 2021
First decision: October 17, 2021
Revised: October 26, 2021
Accepted: December 21, 2021
Article in press: December 21, 2021
Published online: January 18, 2022
Processing time: 293 Days and 20.7 Hours
Abstract
BACKGROUND

Four-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF.

AIM

To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.

METHODS

The systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.

RESULTS

A total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.

CONCLUSION

The 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.

Keywords: Four-corner fusion; Partial wrist arthrodesis; Midcarpal arthrodesis; Scapholunate collapse wrist; Scaphoid nonunion advanced collapse; Scaphoid nonunion

Core Tip: Four-corner fusion is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to scaphoid advanced collapse or longstanding scaphoid nonunion advanced collapse. Our systematic review evaluated long-term clinical and radiographic outcomes of the four-corner fusion and critically appraised the methodology of studies. The results showed that four-corner fusion is capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion. Recommendations for future research are provided.