Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes®): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation

Abstract

Long persisting scaphoid non-unions or scapholunate ligament ruptures can lead to carpal collapse. The resulting clinical symptoms are restrictions in the range of motion, pain, and loss of grip strength. The symptomatic treatment so far offers different options. In our study, the Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate) by Synthes® was used in 11 cases of advanced carpal collapse for a four-corner fusion of the wrist. The intra- and postoperative as well as follow-up results have been assessed and compared with those of current literature. The results of the Manchester-Modified Disability of the Shoulder, Arm and Hand Score (M²-Dash) showed an average of 41.5 points (MD=44/SD=16.62/MIN=21/MAX=65). One of the re-evaluated patients complained about pain at rest. One patient stated pain after mild strain; 4 patients complained pain after heavy burden (e.g. boxing, weight lifting). Measuring the range of motion, the operated hand showed a maximum in dorsal extension of 78.31% and in flexion of 57.89% compared to the contralateral, non-operated hand. In performance testing the fist clenching sign as well as pinch grip were complete and void of pain in 100%, whereas opposition (dig. man. I to V) was complete in five patients (83.33%), with moderate pain in one patient (16.67%) and a persisting gap of 0.2 cm in n=1 (16.67%). In comparison with the current literature regarding healing rates, complications, and follow-up results, we recommend the Synthes® VA LCP ICF Plate as a good surgical option in patients suffering from advanced carpal collapse.