ARTRODESIS DE LAS CUATRO ESQUINAS DEL CARPO, CON PLACA Y TORNILLOS.

  • A. Jiménez Martín Hospital FREMAP Sevilla
Palabras clave: Cirugía Ortopédica

Resumen

INTRODUCCIÓN Y OBJETIVOS:La artrodesis de las cuatro esquinas (grande, ganchoso, semilunar y piramidal) suprime el movimiento de esta articulación  (30% del total del movimiento de la muñeca) y permite movimiento sin dolor en la articulación radiocarpiana (63-70%).  Nuestro objetivo es revisar nuestra experiencia con esta técnica realizada con placa y tornillos. MATERIAL Y MÉTODOS:Estudio observacional, descriptivo y retrospectivo, sobre 11 pacientes, en 6 años, seguimiento medio de 29.4 ± 8 meses.  Variables analizadas: filiación, lesiones asociadas, intervenciones previas, aspectos quirúrgicos, complicaciones, entre otras. Edad media: 41.6 ± 5.8 años. Todos varones. 72.7% derechas. Muñeca dominante: 72.7%. Fractura previa escafoidea (3 casos), inestabilidad escafolunar (7 casos) e inestabilidad lunotriquetal (1 caso).  Tiempo quirúrgico: 92.2 ± 24.7 minutos.   RESULTADOS:Consolidación: 10.6 ± 1.6 semanas. Hubo hasta un 36.4% de reintervenciones, para retirar placa y realizar artrodesis total de muñeca.  Los resultados clínicos fueron: Mayo Elbow Wrist Score: 53.6 ± 28.4 puntos y  V.A.S. final: 2.86 ± 2 puntos.  Hallamos más complicaciones en aquellos pacientes que habían presentado lesiones previas escafolunares, p=0.01 (Chi Cuadrado).  Se observó pseudoartrosis en el 11.1%. Los arcos de movimiento finales fueron: Flexoextensión  final de 58.2 ± 11º, desviación radial de 11.1 ± 1º y desviación cubital de 20.7 ± 1.7º. DISCUSIÓN:En nuestra experiencia, consideramos su eficacia en el tratamiento de las secuelas fundamentalmente tras inestabilidad escafolunar, aunque con riesgo de otras complicaciones, que han llevado en esta serie a reintervenir a la tercera parte de los casos, para retirarla y realizar artrodesis total de muñeca.

Biografía del autor/a

A. Jiménez Martín, Hospital FREMAP Sevilla
Facultativo Adjunto al Servicio de Cirugía Ortopédica y Traumatología.Hospital FREMAP Sevilla.

Citas

González Del Pino J , Campbell D, Fischer T, et al. Variable angle locking intercarpal fusion system for four-corner arthrodesis: indications and surgical technique. J Wrist Surg.2012 Aug;1(1):73-8. DOI:10.1055/s-0032-1323640. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Variable+angle+locking+intercarpal+fusion+system+for+four-corner+arthrodesis%3A+indications+and+surgical+technique.

García López A, Delgado P. J. Artrodesis parciales: fusión de las cuatro esquinas. Patología del Aparato Locomotor.2007; Vol 5, Supl II: 97-104 . Enlace web: http://www.mapfre.com/ccm/content/documentos/fundacion/salud/revista-locomotor/vol5-supl2-art16-artrodesis-parcial.PDF.

Collins ED, Nolla J. Spider plate fixation: no significant improvement in limited wrist arthrodesis. Tech Hand Up Extrem Surg.2008 Jun;12(2):94-9. DOI:10.1097/BTH.0b013e31815e4580. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18528236.

Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus fourcorner arthrodesis. Hand Surg Am.1995 Nov;20(6):965-70. DOI: DOI:10.1016/S0363-5023(05)80144-3. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8583069.

Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg.2008;33A:635-42. DOI:10.1016/j.jhsa.2008.02.001. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Four-corner+arthrodesis+using+a+circular+plate+and+distal+radius+bone+grafting%3A+a+consecutive+case+series.

Bedford B, Yang SS. High fusion rates with circular plate fixation for four-corner arthrodesis of the wrist. Clin Orthop Relat Res.2010;468:163-8. DOI:10.1007/s11999-009-1139-5. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19838645.

Chaudhry T, Spiteri M, Power D, et al. Four corner fusion using a multidirectional angular stable locking plate. World J Orthop.2016 Aug 18;7(8):501-6. DOI:10.5312/wjo.v7.i8.501. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Four+corner+fusion+using+a+multidirectional+angular+stable+locking+plate.

Lamas Gomez C, Proubasta Renart I, Llusa Perez M. Relationship Between Wrist Motion and Capitolunate Reduction in Four-Corner Arthrodesis. Orthopedics.2015 Nov;38(11):e1040-5. DOI: 10.3928/01477447-20151020-14. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Relationship+Between+Wrist+Motion+and+Capitolunate+Reduction+in+Four-Corner+Arthrodesis.

Eid A. Scaphoid Excision and Four-Corner Fusion for Neglected Perilunate Dislocations: Preliminary Results. Hand Surg.2015;20(2):280-4. DOI: 10.1142/s0218810415500240. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Scaphoid+Excision+and+Four-Corner+Fusion+for+Neglected+Perilunate+Dislocations%3A+Preliminary+Results

Trail IA, Murali R, Stanley JK, et al. The long-term outcome of four-corner fusion. J Wrist Surg.2015 May;4(2):128-33. DOI: 10.1055/s-0035-1549277. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25945298.

Foumani M , Strackee SD, Stekelenburg CM, et al. Dynamic in vivo evaluation of radiocarpal contact after a 4-corner arthrodesis. J Hand Surg Am.2015 Apr;40(4):759-66. DOI: 10.1016/j.jhsa.2014.11.028. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Dynamic+in+vivo+evaluation+of+radiocarpal+contact+after+a+4-corner+arthrodesis.

Rudnick B , Goljan P, Pruzansky JS, et al. Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes. Hand (N Y).2014 Sep;9(3):315-21. DOI: 10.1007/s11552-014-9617-y. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Four-corner+arthrodesis+with+a+radiolucent+locking+dorsal+circular+plate%3A+technique+and+outcomes.

Neubrech F , Mühldorfer-Fodor M, Pillukat T, et al. Long-term results after midcarpal arthrodesis. J Wrist Surg.2012 Nov;1(2):123-8. DOI: 10.1055/s-0032-1329616. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24179715.

Khan SK, Ali SM, McKee A, et al. Outcomes of four-corner arthrodesis using the Hubcap circular plate. Hand Surg.2013;18(2):215-20. DOI: 10.1142/S0218810413500263. Enlace Pubmed; https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcomes+of+four-corner+arthrodesis+using+the+Hubcap+circular+plate.

Xu YQ, Zhu YL, Wang Y. The memory plate for four-corner fusion of scaphoid non-union advanced collapse. J Plast Surg Hand Surg.2013 Dec;47(6):442-5. DOI: 10.3109/2000656X.2013.777844. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=The+memory+plate+for+four-corner+fusion+of+scaphoid+non-union+advanced+collapse.

Chung KC, Watt AJ, Kotsis SV. A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity. Plast Reconstr Surg.2006 Aug;118(2):433-42. DOI: 10.1097/01.prs.0000227737.90007.5d. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=A+prospective+outcomes+study+of+four-corner+wrist+arthrodesis+using+a+circular+limited+wrist+fusion+plate+for+stage+II+scapholunate+advanced+collapse+wrist+deformity.

Tomaino MM, Miller RJ, Burton RI. Outcome assessment following limited wrist fusion: Objective wrist scoring versus patient satisfaction. Contemp Orthop.1994 May;28(5):403-10. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcome+assessment+following+limited+wrist+fusion%3A+Objective+wrist+scoring+versus+patient+satisfaction.

Shindle MK, Burton KJ, Weiland AJ, et al. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur Vol.2007 Feb and 32(1):50-3. DOI: 10.1016/j.jhsb.2006.08.016. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17049699.

Kendall CB, Brown TR, Millon SJ, et al. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg.2005;30A:903-7. DOI: 10.1016/j.jhsa.2005.04.007. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16182043.

Weiss AP. Results of four-corner arthrodesis using dorsal circular plate fixation.Weiss AP. J Hand Surg.2006;31A:327-8 . DOI: 10.1016/j.jhsa.2005.11.003. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16473700.

Vance MC, Hernandez JD, DiDonna ML et al. Complications and outcome of four-corner arthrodesis: circular plate

fixation versus traditional techniques. J Hand Surg [Am].2005;30A(6):1122-7. DOI: 10.1016/j.jhsa.2005.08.007. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16344166.

De Smet L, Deorez P, Duerinckyx J, et al. Outcome of four-corner arthrodesis for advanced carpal collapse: circular plate versus traditional techniques. Acta Orthop Belg.2009;75:323-7. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Outcome+of+four-corner+arthrodesis+for+advanced+carpal+collapse%3A+circular+plate+versus+traditional+techniques.

Kraisarin J, Dennison DG, Berglund LJ, et al. Biomechanical comparison of three fixation techniques used for four-corner arthrodesis. J Hand Surg.2011;36B:560-7. DOI: 10.1177/1753193411406799. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Biomechanical+comparison+of+three+fixation+techniques+used+for+four-corner+arthrodesis.

Rhee PC, Shin AY. The rate of successful four-corner arthrodesis with a locking, dorsal circular polyether-ether-ketone (PEEK-Optima) plate. J Hand Surg Eur Vol.2013 Sep; 38(7): 767-73. DOI: 10.1177/1753193413475962. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=The+rate+of+successful+four-corner+arthrodesis+with+a+locking%2C+dorsal+circular+polyether-ether-ketone+(PEEK-Optima)+plate.

Hernekamp JF, Reinecke A, Neubrech F, et al. Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate. Arch Orthop Trauma Surg.2016 Apr;136(4):571-8. DOI: 10.1007/s00402-016-2416-x. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Four-corner+fusion%3A+comparison+of+patient+satisfaction+and+functional+outcome+of+conventional+K-wire+technique+vs.+a+new+locking+plate.

Le Corre A, Ardouin L, Loubersac T, et al. Retrospective study of two fixation methods for 4-corner fusion: Shape-memory staple vs. dorsal circular plate. Chir Main.2015 Dec;34(6):300-6. DOI: 10.1016/j.main.2015.08.008. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Retrospective+study+of+two+fixation+methods+for+4-corner+fusion%3A+Shape-memory+staple+vs.+dorsal+circular+plate.

Pauchard N, Lecoanet-Strugarek C, Segret J, et al. Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study. Orthop Traumatol Surg Res.2014 Oct;100(6):593-7. DOI: 10.1016/j.otsr.2014.05.016. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Dorsal+locking+plates+versus+staples+in+four-corner+fusion%3A+a+comparative+clinical+and+radiological+study.

Cárdenas Grande E, Correa Gámiz JJ, Gómez Sánchez RC, et al. Evaluación clínico radiográfica de una serie de 18 carpectomías de la primera hilera. Rev.S.And.Traum.y Ort., 2014; 31 (2/2): 25-32 . Enlace web: http://www.portalsato.es/documentos/revista/Revista14-2/2014-2.%2004.pdf.

Laronde P, Christiaens N, Aumar A, et al. Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study. Hand Surg Rehabil.2016 Apr;35(2):100-6. DOI: 10.1016/j.hansur.2016.01.003. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Carpal+height+and+postoperative+strength+after+proximal+row+carpectomy+or+four-corner+arthrodesis%3A+Clinical%2C+anatomical+and+biomechanical+study.

Berkhout MJ, Bachour Y, Zheng KH, et al. Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years. Hand Surg Am.2015 Jul;40(7):1349-54. DOI: 10.1016/j.jhsa.2014.12.035. Enlace PubMed https://www.ncbi.nlm.nih.gov/pubmed/?term=Four-Corner+Arthrodesis+Versus+Proximal+Row+Carpectomy%3A+A+Retrospective+Study+With+a+Mean+Follow-Up+of+17+Years.

Debottis DP, Werner FW, Sutton LG, et al. 4-corner arthrodesis and proximal row carpectomy: a biomechanical comparison of wrist motion and tendon forces. J Hand Surg Am.2013 May;38(5):893-8. DOI: 10.1016/j.jhsa.2013.01.033. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=4-corner+arthrodesis+and+proximal+row+carpectomy%3A+a+biomechanical+comparison+of+wrist+motion+and+tendon+forces:.

Shindle MK, Burton KJ, Weiland AJ, et al. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur Vol.2007 Feb;32(1):50-3. DOI: 10.1016/j.jhsb.2006.08.016. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17049699.

Manuel JL, Weiss AP. Scapholunocapitate arthrodesis using the mini-spider plate. Tech Hand Up Extrem Surg.2003 Sep;7(3):87-92. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Scapholunocapitate+arthrodesis+using+the+mini-spider+plate.

Rodgers JAJA, Holt G Finnerty EP et al. Scaphoid excision and limited wrist fusion: a comparison of K-wire and circular plate fixation. Hand.2008;3:276-281. DOI: 10.1007/s11552-008-9099-x. Enlace PubMed:https://www.ncbi.nlm.nih.gov/pubmed/?term=Scaphoid+excision+and+limited+wrist+fusion%3A+a+comparison+of+K-wire+and+circular+plate+fixation

Enna M, Hoepfner P, Weiss AP. Scaphoid excision with four-corner fusion. Hand Clin.2005 Nov;21(4):531-8. DOI: 10.1016/j.hcl.2005.08.012. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/?term=Scaphoid+excision+with+four-corner+fusion++Enna.

Rhee PC, Kakar S, Shin AY. Four-corner arthrodesis with a locking, dorsal circular polyether-ether-ketone (PEEK-Optima) plate. Tech Hand Up Extrem Surg.2012 Dec;16(4):236-41. DOI: 10.1097/BTH.0b013e31826d221a. Enlace PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23160559.

Publicado
2018-05-24
Sección
Articulos Originales