Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations.

PURPOSE: Several operative approaches and various implants for osseous fixation have been described to achieve four-corner fusion of the wrist. Given the discordance and to aid in further standardizing the technique, this study directly compares the outcomes of K-wire, fusion plate, and headless retrograde compressive screw fixations to achieve four-corner arthrodesis. METHODS: Sixty-four patients underwent four-corner fusion over a period of 5 years and were reviewed retrospectively. Twenty-one patients underwent bone fixation with conventional K-wires, 26 with locking plates, and 17 patients were treated by headless retrograde compressive screw fixations. Patients of the different groups were comparable regarding age, sex, hand dominance, and stage of disease. RESULTS: All study groups showed significant improvements in grip strength, decrease in pain (NRS) at rest and with activity, range-of-motion of the wrist, and wrist function (measured by the DASH-score). When evaluating the three groups amongst each other, overall complication and nonunion rates were low and revealed no significant differences between the groups of patients. However, regarding postoperative NRS at activity, dorsal flexion, and DASH-scores, the "screw" group showed significantly better results than the "wire" group. CONCLUSION: The results show that all examined techniques of four-corner fusion can improve wrist function when compared to preoperative baseline (NRS at rest and activity, postoperative DASH-scores). However, headless retrograde compressive screw fixation had significant better results regarding pain relief (NRS) at activity and postoperative DASH-scores.

Total Endoprosthesis Versus Lundborg´s Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis.

BACKGROUND: There exist various operative approaches for the treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundsborg's resection arthroplasty (RA) with implantation of a total endoprosthesis. PATIENTS AND METHODS: In this 2-center study, we retrospectively analyzed 71 patients with symptomatic osteoarthritis of the carpometacarpal I joint stage III according to the Eaton-Littler classification. Thirty-two patients underwent a Lundsborg's RA group, and 39 patients received a total endoprosthesis of the carpometacarpal I joint (TEP group). We evaluated operative time, DASH score, postoperative time until resolution of symptoms, pain level, pinch force, and satisfaction with the treatment. RESULTS: Both groups had a similar mean length of follow-up of 42 months (TEP group) and 36 months (RA group). The final DASH score was significantly better in the TEP-group (10.1 versus 21.5 in the RA group; P ≤ 0.05). Also, the time interval from surgery till absence of any pain (1.5 versus 5.9 months) and the time of inability to work (6 versus 21 weeks) were significantly shorter for the TEP group compared with the RA group (P ≤ 0.05). The pinch force, pain intensity, and the satisfaction with the treatment were comparable (P > 0.05). The duration of the operation was significantly shorter in the RA group (31 min versus 65 min in the TEP group; P ≤ 0.05). CONCLUSION: Both techniques resulted in improved function of the operated hand and a clear reduction of symptoms. However, the implantation of a total endoprosthesis seems to have advantages, given a significantly better DASH score and a significantly shorter time until resolution of symptoms.

Autologous Fat Injection versus Lundborg Resection Arthroplasty for the Treatment of Trapeziometacarpal Joint Osteoarthritis.

BACKGROUND: Various operative approaches exist for treatment of trapeziometacarpal joint osteoarthritis. The aim of this study was to compare the results of Lundborg resection arthroplasty with solely autologous fat injection. METHODS: Twenty-one patients with symptomatic osteoarthritis of the trapeziometacarpal joint (Eaton-Littler classification stages III/IV) underwent either a Lundborg resection arthroplasty (n = 12) or autologous fat injection into the trapeziometacarpal joint (n = 9). Both groups were comparable regarding demographic and clinical data. Patient records were evaluated retrospectively regarding operative time; Disabilities of the Arm, Shoulder, and Hand questionnaire score; postoperative time until resolution of symptoms; pain level; grip and pinch force; and satisfaction with the treatment. RESULTS: Both groups had similar length of follow-up of at least 12 months. The duration of the operation was significantly shorter in the fat group (13 ± 5 minutes) compared with the resection group (31 ± 5 minutes) (p < 0.05). The Disabilities of the Arm, Shoulder, and Hand questionnaire score (resection group, 21.9 ± 6.2; fat group, 24.0 ± 5.0) and the pain level at follow-up (resection group, 1.0 ± 0.7; fat group, 2.9 ± 0.8) were comparable (p > 0.05). The time until complete resolution of symptoms was significantly shorter in the fat group (1.7 ± 2.1 months) compared with the resection group (5.7 ± 3.1 months) (p < 0.05). Grip and pinch strength and overall satisfaction with the treatment were comparable (p > 0.05). CONCLUSION: Both autologous fat grafting and Lundborg resection arthroplasty resulted in improved function of the operative hand and a clear reduction of symptoms, whereas autologous fat injection seems to have advantages attributable to a shorter time until resolution of symptoms and shorter operative times. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.