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Four Corner Arthrodesis Using a Funnel Shaped Plate Allowing Multi-Planar Fixation
Arnold Peter Weiss, MD1; Amy Ladd, MD2
1Brown University, Providence, RI; 2Stanford University, Stanford, CA

Most four corner fusion plates provide fixation with screws in a single plane relying on the screw threads for bone stability. We have used a novel plate which provides multi-planar fixation via locking screws and autogenous bone grafting to address SLAC / SNAC wrists which provides fixation via screw threads and screw shaft divergence to enhanced stability.

Methods: A retrospective clinical and radiographic assessment was performed in a consecutive cohort of 15 patients who underwent a standardized four corner arthrodesis with a Titanium, funnel-shaped plate and distal radius bone grafting for a diagnosis of SLAC or SNAC wrist. Follow-up examination of all patients included VAS pain scores, VAS activity ratings, work status, PA/lat radiographs, grip strength, range of motion, and complications/re-operations was obtained on each patient.

Results: Average follow-up was 28 months (minimum = 2 years). Radiographs demonstrated union in all (100%) of cases, no screw breakage, carpal collapse, or unexplained severe pain. In addition, no evidence of secondary arthritic changes at the radiolunate joint were noted, with maintenance of joint height. No plates required removal. Range of motion averaged 58% of the uninjured side (avg. extension=470; ave flexion=340). Grip strength averaged 82% of the uninjured side (45 kg vs 55 kg). The mean VAS pain and activity scores were 1.3/10 and 2.2/10.

Conclusions: The use of a novel funnel-shaped plate which allows fixation of the 4 corner region via both screw threads and screw shaft divergence in a locked rigid construct produced excellent and reproducible results in this consecutive series with direct follow-up examination. Importantly, the development of secondary arthritic changes at the radiolunate joint were not noted indicating a reasonable durability to the procedure.

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