Long-term outcomes of the four-corner fusion of the wrist: A systematic review

Table 1 Criteria for study selection

Inclusion criteria	Exclusion criteria
Human studies in English or German language	Oral presentations, cadaveric or review articles, animal studies
Minimum Level IV case series studies using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence	Language not in English or German
Four corner fusion surgery using any technique	Minimum follow-up less than 5 yr
A minimum follow-up of 5 yr	Inflammatory arthropathy as etiology
Clinical and radiographic data including patient-reported outcomes, grip/pinch strength, range of motion, fusion rates, revisions or complications have been reported	Insufficient outcome data reported

Table 2 Demographics, surgical techniques and patient-reported outcomes

Author	Year	Study design	Number of wrists	Indication	Mean age (yr)	Fixation Technique	VAS		DASH		MINORS (%)
							Preop	Postop	Preop	Postop
Cha SM	2013	Retrospective case series	40	SLAC	47	K-wires	6.3	2.0	44	17	75
Luegmair M	2012	Retrospective case series	24	SLAC, SNAC, SCAC	53	Plates	-	-	-	19	75
Bain GI	2010	Prospective cohort study	31	SLAC	47	Staples	6.0	1.0	-	-	87
Berkhout MJL	2015	Retrospective cohort study	8	SLAC, SNAC	45	K-wires	-	0.3	-	-	62
Kitzinger HB	2003	Retrospective case series	37	SLAC, SNAC	46	K-wires	2.7	1.7	-	24	62
Trail I	2015	Retrospective case series	116	SLAC, SNAC	47	K-wires, Plates, Staples, Screws	-	1.9	-	37	62
Neubrech F	2012	Retrospective case series	60	SLAC, SNAC, unclassified OA	63	K-Wires	-	1.4	-	20	87
Odella S	2018	Retrospective case series	20	SLAC, SNAC	53	Plates	-	2.0	-	17	62
Traverso P	2017	Retrospective case series	15	SLAC, SNAC	49	K-wires	-	-	-	8	62
Wagner ER	2017	Retrospective cohort study	51	Unclassified OA	34	Plates	-	-	-	19	75
Williams J	2018	Retrospective cohort study	61	SLAC, SNAC, perilunate OA	52	K-wires, Plates, Screws	-	1.0	-	27	50
Total/Averages			463		49			1.4		21	69
SD					± 7			± 0.6		± 8	± 11

SD: Standard deviation; VAS: Visual analog scale; DASH: Disabilities of the Arm, Shoulder and Hand questionnaire; SLAC: Scapholunate advanced collapse; SNAC: Scaphoid nonunion advanced collapse; SCAC: Scaphoid chondrocalcinosis advanced collapse; MINORS: Methodological items for non-randomized studies; OA: Osteoarthritis; K-wires: Kirschner wires.

Table 3 Fusion rates, survivorship including rates of conversion to total wrist fusion and complications

Author	Number of wrists	Fixation technique	Nonunion (n)	Fusion (%)	Revisions (%)	Conversion to TWF (%)	Complications
Cha SM	40	K-wires	0	100	2 (5)	1 (3)	1 x impingement
Luegmair M	24	Plates	2	92	2 (8)	0	-
Bain GI	31	Staples	3	90	5 (16)	2 (7)	1 x delayed union
Berkhout MJL	8	K-wires	1	88	-	-	1 x CRPS, 1 x delayed union
Kitzinger HB	37	K-wires	-	-	-	-	-
Trail I	116	K-wires, plates, staples, screws	28	76	14 (12)	6 (5)	3 x impingement
Neubrech F	60	K-wires	-	-	-	-	-
Odella S	20	Plates	0	100	1 (5)	0	1 x implant loosening
Traverso P	15	K-wires	0	100	2 (13)	1 (7)	-
Wagner ER	51	Plates	6	88	15 (29)	6 (12)	1 x infection, 8 x impingement
Williams J	61	K-wires, plates, screws	3	95	21 (34)	12 (20)	4 x impingement, 1 x ulnar impaction, 1 x infection
Totals/Averages	463		43 (9%)	91 ± 7	62 (13%)	28 (6%)

TWF: Total wrist fusion; CRPS: Complex regional pain syndrome; K-wires: Kirschner wires.

Table 4 Range of motion and grip strength

Author	Grip strength (%)		ROM Flexion-extension		ROM radial-ulnar (%)
	Preop	Postop	Preop	Postop	Preop	Postop
Cha SM	71	85	84	66	45	39
Luegmair M	38	70	57	64	24	30
Bain GI	27	30	78	57	35	30
Berkhout MJL	-	-	-	87	-	49
Kitzinger HB	69	80	68	62	35	34
Trail I	-	53	-	60	-	26
Neubrech F	-	85	-	63	-	30
Odella S	-	75	-	79	-	-
Traverso P	-	-	-	69	-	33
Wagner ER	60	65	-	54	-	32
Williams J	-	-	-	-	-	-
Averages	53	68	72	66	35	34
SD	± 17	± 18	± 10	± 10	± 8	± 6

ROM: Range of motion; SD: Standard deviation; Preop: Preoperative; Postop: Postoperative.