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Four-Corner Fusion with a Locking, Circular Dorsal Plate
Benjamin H. Rudnick; Abdo Bachoura, MD; Sidney M. Jacoby, MD; Peter Goljan, MD; Mark S. Rekant, MD
Thomas Jefferson University, Philadelphia, PA

Introduction: Four-corner arthrodesis (FCA) has been shown to be an acceptable salvage procedure for the treatment of wrist osteoarthritis. The use of metallic circular plates for FCA has generally resulted in inconsistent outcomes. More recently, a locking, dorsal circular plate (LDCP) composed of polyether-ether ketone (PEEK) has been introduced (XpodeŽ; TriMed Inc., Santa Clarita, CA). In theory, this plate allows optimal locking screw placement and more accurate assessments using plain film imaging studies. The purpose of the study is to better assess the efficacy of this specific plate design for FCA.
Materials and Methods: A retrospective chart review of all patients who underwent FCA with an XpodeŽ between 1/1/2008 and 12/31/2012 was conducted. Patient demographics, preoperative and postoperative range of motion, grip strength, and complications were collected from the medical records. Patients were also asked to complete the Patient Rated Wrist Evaluation. A paired t-test was used to compare means and a p-value less than 0.05 was considered statistically significant.
Results: There were 20 males and 2 female patients, with a mean age of 49.5 years (range, 28 to 72 years) at the time of surgery. A total of 23 procedures were performed: 10 right-sided and 13 left-sided. The post-operative follow up duration averaged 9 months (range, 2 to 36). Mean pre and postoperative wrist extension was 25° and 30° respectively, n= 23, p=0.11. Mean pre and postoperative wrist flexion values were both 27°, n=23, p=0.5. Average grip strength was 61 lbs. preoperatively and 62 lbs. postoperatively, n = 8, p =0.489. The mean total PRWE was 42 (range, 8-66) with a mean pain score of 20 (range, 4-31) at a follow-up duration of 36 months (range, 17 to 52 months). 6 patients developed a total of 7 complications, including wrist contractures (3), progressive arthritis requiring DRUJ arthroplasty (1) and total wrist fusion (1). 2 patients had hardware related complications, one of which required removal.
Conclusion: Postoperative range of motion and grip strength revealed maintenance of function, which is encouraging. Given the average follow up period of 9 months, FCA with a LDCP yields reasonable results with some complications requiring additional surgery. A longer clinical follow up duration is required to fully assess the efficacy of this implant.


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