Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases

Abstract

Background

Four-corner fusion (4CF) is a known treatment option for degenerative wrist conditions. Different techniques may be used and there is no general consensus on best implant. As such, it was the purpose of the current systematic review to compare fusion rates and outcomes depending on the fixation technique.

Methods

The systematic review was registered in the international prospective register of systematic reviews (PROSPERO): CRD42020164301. It followed the PRISMA guidelines. Original articles were screened using the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and Web of Science Core Collection. Studies reporting on outcome for 4CF surgery were included. Studies with a minimum Level IV of evidence were considered eligible. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results

A total of 29 studies met the inclusion criteria, for a total of 1103 wrists. The mean age was 41.8 years (range 19–83). Mean follow-up overall was 43.5 months (range 24–146 months). Reported fusion weighted rates were >90% and did not differ significantly between techniques. Reoperations due to different reasons occurred in 135 (12%) of all 1103. There was significant data heterogeneity regarding fusion rates (I² = 70%). Inconsistency and heterogeneity in data reporting did not allow meta-analysis with direct data pooling and comparison of subgroups.

Conclusions

Satisfactory fusion rates (over 90%) can be achieved independent of the fixation technique used in 4-corner arthrodesis. Due to the high data heterogeneity and reporting inconsistency across studies, no statements regarding PROMs, ROM or grip strength can be made.

Level of evidence

Systematic Review of Level IV Studies.

Keywords:

• Four-corner fusion
• partial wrist arthrodesis
• SLAC wrist
• SNAC
• scaphoid nonunion

Disclosure statement

The author(s) declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article. OA conceived the study, established the protocol, performed literature research, quality assessment, wrote first draft of manuscript. RL extracted data, performed analysis, quality assessment and wrote first draft of the manuscript. PK established protocol and performed literature research. DK performed statistical analysis and literature search. AF and LN reviewed and edited the manuscript. AS was involved in establishing the protocol and reviewed and edited the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Additional information

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.