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Results of Scaphoid Excision, Four-Corner Fusion Using a Circular PEEK Plate
Amy Speeckaert, MD; Justin G. Brothers, MD; Joel C. Klena, MD
Geisinger Medical Center, Danville, PA

Introduction: Scaphoid excision with four-corner arthrodesis (four corner arthrodesis) has proven effective in reducing pain while preserving motion in patients with severe radioscaphoid arthritis. Clinical results of several operative techniques for four corner arthrodesis have been reported in the literature. In this study, early results and subjective outcome scores are reported for four corner arthrodesis using a locking dorsal circular plate (LDCP) composed of polyether-ether-ketone (PEEK-Optima) with locking stainless steel screws.
Materials & Methods: We conducted a retrospective review of 14 consecutive four-corner arthrodeses performed by a single surgeon using the PEEK-Optima implant. Post-operative visual analog scale scores, functional outcome scores, radiographic evaluation, objective evaluation of motion and work status were recorded.
Results: The average follow up period was 20 months. One patient was lost after 2 months due to out of state transfer within the federal correctional system. One patient underwent revision surgery for failure to fuse with subsequent successful arthrodesis. The remaining 13 patients demonstrated radiographic union on or prior to 12 week post-operative radiographs. No patient demonstrated dorsal impingement under fluoroscopic examination in the operating room. Average wrist extension and flexion were 85% and 58% of the unaffected side, respectively. Average radial and ulnar deviation were 92 and 60% of the unaffected side, respectively. Grip strength averaged 73% of the unaffected side while average pinch strength was 90% of the unaffected side. Average visual analog score (VAS) was 0.6 at rest and 4 with repetitive motion. Eleven out of 14 (78.6%) patients reported they would have the procedure done again. The average Disabilities of Arm Shoulder and Hand score was 24. Ten of 11 (90.9%) employed patients returned to their pre-surgery occupation.
Conclusions: Four corner arthrodesis using a LDCP plate composed of PEEK-Optima with locking stainless steel screws produced acceptable results in this series of 14 consecutive patients. Thirteen of 14 patients achieved evidence of radiographic union following the index procedure. Average range of motion and VAS scores were comparable or superior to results previously reported with the use of a recessed circular dorsal plate.


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