Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

Abstract

Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon.

Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series.

Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE).

Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values.

Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months.

Level of Evidence Level IV, therapeutic study.

Keywords

basal thumb arthritis - four-corner fusion - limited wrist arthrodesis - partial wrist fusion - midcarpal arthritis - trapeziometacarpal arthritis

Note

This study was performed at Victorian Hand Surgery Associates. This study has been granted ethics approval by the St. Vincent's Hospital Melbourne Human Research Ethics Committee, HREC No. HREC/16/SVHM/113.

• References

• 1 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
• 2 Yuan BJ, Moran SL, Tay SC, Berger RA. Trapeziectomy and carpal collapse. J Hand Surg Am 2009; 34 (02) 219-227
• 3 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (03) 340-341
• 4 Ferris BD, Dunnett W, Lavelle JR. An association between scapho-trapezio-trapezoid osteoarthritis and static dorsal intercalated segment instability. J Hand Surg [Br] 1994; 19 (03) 338-339
• 5 Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report. J Hand Surg Am 1995; 20 (3 Pt 2): S82-S85
• 6 Burton RI, Pellegrini Jr VDJ. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (03) 324-332
• 7 Shin AY. Four-corner arthrodesis. J Am Soc Surg Hand 2001; 1 (02) 93-111
• 8 Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin 1987; 3 (04) 455-471
• 9 Nattrass GR, King GJ, McMurtry RY, Brant RF. An alternative method for determination of the carpal height ratio. J Bone Joint Surg Am 1994; 76 (01) 88-94
• 10 Goffin D, Saffar P. A radiological technique for measurement of the height of the trapezial cavity. Applications in pre- and post-operative assessment in osteoarthritis of the base of the thumb. Ann Chir Main Memb Super 1990; 9 (05) 364-368
• 11 Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg Am 2001; 26 (05) 862-868
• 12 Larsen CF, Mathiesen FK, Lindequist S. Measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg Am 1991; 16 (05) 888-893
• 13 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
• 14 Gangopadhyay S, McKenna H, Burke FD, Davis TRC. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37 (03) 411-417
• 15 Trail IA, Murali R, Stanley JK. , et al. The long-term outcome of four-corner fusion. J Wrist Surg 2015; 4 (02) 128-133
• 16 Waitzenegger T, Leclercq C, Masmejean E. , et al. Combined treatment of wrist and trapeziometacarpal joint arthritis. J Wrist Surg 2015; 4 (04) 301-306
• 17 Klum M, Wolf MB, Hahn P, Leclère FM, Bruckner T, Unglaub F. Normative data on wrist function. J Hand Surg Am 2012; 37 (10) 2050-2060
• 18 Merrell GA, McDermott EM, Weiss A-PC. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am 2008; 33 (05) 635-642
• 19 Espinoza DP, Schertenleib P. Four-corner bone arthrodesis with dorsal rectangular plate: series and personal technique. J Hand Surg Eur Vol 2009; 34 (05) 609-613
• 20 Neubrech F, Mühldorfer-Fodor M, Pillukat T, Schoonhoven Jv, Prommersberger KJ. Long-term results after midcarpal arthrodesis. J Wrist Surg 2012; 1 (02) 123-128
• 21 De Smet L. The DASH questionnaire and score in the evaluation of hand and wrist disorders. Acta Orthop Belg 2008; 74 (05) 575-581
• 22 De Smet L, Vandenberghe L, Degreef I. Long-term outcome of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) versus prosthesis arthroplasty for basal joint osteoarthritis of the thumb. Acta Orthop Belg 2013; 79 (02) 146-149