A Prospective Outcomes Study of Four-Corner Wrist Arthrodesis Using a Circular Limited Wrist Fusion Plate for Stage II Scapholunate Advanced Collapse Wrist Deformity

Author(s): Chung KC, Watt AJ, Kotsis SV

Source: Plastic & Reconstructive Surgery 118:  433-42, 2006.


This is a prospective study evaluating the outcome of four-corner wrist fusion in a group of patients with stage II SLAC wrist.  The patients were enrolled consecutively at a single academic center, and the procedure was performed by a single surgeon using the KMI Spider Limited Wrist Fusion Plate.  Data on function and outcomes parameters were collected preoperatively and at 6 and 12 months postoperatively.  Independent functional assessment was performed by a hand therapist.  The Michigan Hand Outcomes Questionnaire was administered preoperatively and at 6 and 12 months postoperatively.  A total of 11 patients were enrolled and 10 completed their 12 month follow-up evaluation.  Three patients had screw breakage.  No other complications were reported.  The results were analyzed statistically and compared with data from previously reported series using K-wire fixation.  Results at one-year showed preservation of preoperative functional values for range of motion, Jebsen-Taylor tests, and pinch strength.  Grip strength decreased significantly at both postoperative evaluations.  No significant postoperative changes were noted in the Michigan Hand Outcomes Questionnaire when compared with the preoperative values.

The authors found that there was no advantage to the use of the Spider plate with respect to outcomes when comparing results from previous studies using K-wires.  Pain was not consistently or significantly relieved in the Spider plate group, which was also noted in the literature using K-wires.  The high (3/11, 27%) complication rate was concerning to the authors, and was higher than the reported complication rate in the historical literature.  They conclude that the Spider plate does not increase patient satisfaction or functional outcomes significantly over earlier technology and has a relatively high complication rate, which must be considered when recommending this operation to patients. 


Wrist, Arthritis, Spider, Fusion, Arthrodesis, Four, Corner

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