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Relationship Between Preoperative and Postoperative Motion After Four-Corner Wrist Fusion for Osteoarthritis: Clustering and Regression Analyses.
Ahmad, Farhan; Ayala, Salvador; Smith, Shelby; Fernandez, John J; Cohen, Mark S; Simcock, Xavier C; Wysocki, Robert W.
Affiliation
  • Ahmad F; Rush University Medical Center. Electronic address: ahmadfr@icloud.com.
  • Ayala S; University of Illinois College of Medicine, Chicago, IL.
  • Smith S; Rush University Medical Center.
  • Fernandez JJ; Rush University Medical Center.
  • Cohen MS; Rush University Medical Center.
  • Simcock XC; Rush University Medical Center.
  • Wysocki RW; Rush University Medical Center.
J Hand Surg Am ; 47(9): 874-880, 2022 09.
Article in En | MEDLINE | ID: mdl-36058565
ABSTRACT

PURPOSE:

Four-corner fusion (4CF) is a surgical option for refractory scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist arthritis. Preoperative range of motion (ROM) predicts outcomes in many orthopedic procedures. This study investigates ROM in a cohort of 4CF patients to examine the relationship between preoperative and postoperative motion and identifies different clinical patterns.

METHODS:

We performed a retrospective review of 4CF patients. Patients with a history of inflammatory arthritis and radiographic characteristics of inflammation were excluded. Demographics, prior wrist surgery history, and ROM data were collected at preoperative and postoperative intervals after cast removal at 8 weeks, 3 months, and 8 months. Regression analysis compared the motion before and after 4CF. Subsequent cluster analysis to reduce confounding compared postoperative motion differences in the top 20% to the bottom 20% of patients by preoperative motion.

RESULTS:

We included 148 patients; 27 had prior surgery on the ipsilateral wrist. Preoperative arc averaged 86° ± 28° (flexion 46° ± 17°, extension 40° ± 15°); 8-week arc 43° ± 19° (flexion 19° ± 12°, extension 24° ± 12°); 3-month arc 62° ± 17° (flexion 30° ± 12°, extension 32° ± 11°); and 8-month arc 74° ± 17° (flexion 36° ± 11°, extension 37° ± 12°). Preoperative and final arcs were (r = 0.39). Clustering by the preoperative arc, the top 20% (mean 124° ± 15°) achieved a mean final arc of 81° ± 16°, while the bottom 20% (mean 47° ± 16°) achieved a mean final arc of 65° ± 19°. Intercluster differences were statistically significant. The bottom 20% gained motion postoperatively. Most patients in the middle 60% did not differ significantly in postoperative motion.

CONCLUSIONS:

Although wrist motion following 4CF correlates positively with preoperative motion, most patients do not differ significantly in postoperative motion. Patients with substantial preoperative motion deficits gain motion after 4CF. This information is important when counseling patients, determining the timing of surgical intervention, and managing expectations related to motion outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Osteoarthritis / Scaphoid Bone Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Hand Surg Am Year: 2022 Type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Osteoarthritis / Scaphoid Bone Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Hand Surg Am Year: 2022 Type: Article