Andronic O, Nagy L, Burkhard MD, Casari FA, Karczewski D, Kriechling P, Schweizer A, Jud L. Long-term outcomes of the four-corner fusion of the wrist: A systematic review. World J Orthop 2022; 13(1): 112-121 [PMID: 35096541 DOI: 10.5312/wjo.v13.i1.112]
Corresponding Author of This Article
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
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Orthop. Jan 18, 2022; 13(1): 112-121 Published online Jan 18, 2022. doi: 10.5312/wjo.v13.i1.112
Table 1 Criteria for study selection
Inclusion criteria
Exclusion criteria
Human studies in English or German language
Oral presentations, cadaveric or review articles, animal studies
Minimum Level IV case series studies using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence
Language not in English or German
Four corner fusion surgery using any technique
Minimum follow-up less than 5 yr
A minimum follow-up of 5 yr
Inflammatory arthropathy as etiology
Clinical and radiographic data including patient-reported outcomes, grip/pinch strength, range of motion, fusion rates, revisions or complications have been reported
Insufficient outcome data reported
Table 2 Demographics, surgical techniques and patient-reported outcomes
Author
Year
Study design
Number of wrists
Indication
Mean age (yr)
Fixation Technique
VAS
DASH
MINORS (%)
Preop
Postop
Preop
Postop
Cha SM
2013
Retrospective case series
40
SLAC
47
K-wires
6.3
2.0
44
17
75
Luegmair M
2012
Retrospective case series
24
SLAC, SNAC, SCAC
53
Plates
-
-
-
19
75
Bain GI
2010
Prospective cohort study
31
SLAC
47
Staples
6.0
1.0
-
-
87
Berkhout MJL
2015
Retrospective cohort study
8
SLAC, SNAC
45
K-wires
-
0.3
-
-
62
Kitzinger HB
2003
Retrospective case series
37
SLAC, SNAC
46
K-wires
2.7
1.7
-
24
62
Trail I
2015
Retrospective case series
116
SLAC, SNAC
47
K-wires, Plates, Staples, Screws
-
1.9
-
37
62
Neubrech F
2012
Retrospective case series
60
SLAC, SNAC, unclassified OA
63
K-Wires
-
1.4
-
20
87
Odella S
2018
Retrospective case series
20
SLAC, SNAC
53
Plates
-
2.0
-
17
62
Traverso P
2017
Retrospective case series
15
SLAC, SNAC
49
K-wires
-
-
-
8
62
Wagner ER
2017
Retrospective cohort study
51
Unclassified OA
34
Plates
-
-
-
19
75
Williams J
2018
Retrospective cohort study
61
SLAC, SNAC, perilunate OA
52
K-wires, Plates, Screws
-
1.0
-
27
50
Total/Averages
463
49
1.4
21
69
SD
± 7
± 0.6
± 8
± 11
Table 3 Fusion rates, survivorship including rates of conversion to total wrist fusion and complications
Author
Number of wrists
Fixation technique
Nonunion (n)
Fusion (%)
Revisions (%)
Conversion to TWF (%)
Complications
Cha SM
40
K-wires
0
100
2 (5)
1 (3)
1 x impingement
Luegmair M
24
Plates
2
92
2 (8)
0
-
Bain GI
31
Staples
3
90
5 (16)
2 (7)
1 x delayed union
Berkhout MJL
8
K-wires
1
88
-
-
1 x CRPS, 1 x delayed union
Kitzinger HB
37
K-wires
-
-
-
-
-
Trail I
116
K-wires, plates, staples, screws
28
76
14 (12)
6 (5)
3 x impingement
Neubrech F
60
K-wires
-
-
-
-
-
Odella S
20
Plates
0
100
1 (5)
0
1 x implant loosening
Traverso P
15
K-wires
0
100
2 (13)
1 (7)
-
Wagner ER
51
Plates
6
88
15 (29)
6 (12)
1 x infection, 8 x impingement
Williams J
61
K-wires, plates, screws
3
95
21 (34)
12 (20)
4 x impingement, 1 x ulnar impaction, 1 x infection
Totals/Averages
463
43 (9%)
91 ± 7
62 (13%)
28 (6%)
Table 4 Range of motion and grip strength
Author
Grip strength (%)
ROM Flexion-extension
ROM radial-ulnar (%)
Preop
Postop
Preop
Postop
Preop
Postop
Cha SM
71
85
84
66
45
39
Luegmair M
38
70
57
64
24
30
Bain GI
27
30
78
57
35
30
Berkhout MJL
-
-
-
87
-
49
Kitzinger HB
69
80
68
62
35
34
Trail I
-
53
-
60
-
26
Neubrech F
-
85
-
63
-
30
Odella S
-
75
-
79
-
-
Traverso P
-
-
-
69
-
33
Wagner ER
60
65
-
54
-
32
Williams J
-
-
-
-
-
-
Averages
53
68
72
66
35
34
SD
± 17
± 18
± 10
± 10
± 8
± 6
Citation: Andronic O, Nagy L, Burkhard MD, Casari FA, Karczewski D, Kriechling P, Schweizer A, Jud L. Long-term outcomes of the four-corner fusion of the wrist: A systematic review. World J Orthop 2022; 13(1): 112-121