Subscribe to RSS
The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis
29 April 2018
07 January 2019
20 February 2019 (online)
Background Midcarpal “four-corner” wrist arthrodesis may be done from an open arthrotomy or arthroscopically.
Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique.
Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse (n = 6), Preiser's disease (n = 1), radioscaphoid (n = 1), or capitolunar (n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws.
Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months.
Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement.
Level of Evidence This is a level IV, retrospective case series.
The research protocol was approved in advance by the hospital management through the Turku Clinical Research center.
- 1 Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1210-1218
- 2 Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 450-457
- 3 Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am 1987; 12 (04) 514-519
- 4 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
- 5 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
- 6 Ashmead IV D, Watson HK, Damon C, Herber S, Paly W. Scapholunate advanced collapse wrist salvage. J Hand Surg Am 1994; 19 (05) 741-750
- 7 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (05) 719-725
- 8 Cha SM, Shin HD, Kim KC. Clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in scapholunate advanced collapse at 5 and 10 years. Ann Plast Surg 2013; 71 (02) 166-169
- 9 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (01) 94-104
- 10 Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am 1994; 19 (05) 751-759
- 11 Mavrogenis AF, Flevas DA, Raptis K. , et al. Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients. Eur J Orthop Surg Traumatol 2016; 26 (08) 859-866
- 12 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (02) 256-263
- 13 Shin AY. Four-corner arthrodesis. J Am Soc Surg Hand 2001; 1 (02) 93-111
- 14 Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg [Br] 1999; 24 (03) 307-315
- 15 Dutly-Guinand M, von Schroeder HP. Three-corner midcarpal arthrodesis and scaphoidectomy: a simplified volar approach. Tech Hand Up Extrem Surg 2009; 13 (01) 54-58
- 16 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
- 17 Gaston RG, Greenberg JA, Baltera RM, Mih A, Hastings H. Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2009; 34 (08) 1407-1412
- 18 Kitzinger HB, Karle B, Prommersberger KJ, van Schoonhoven J, Frey M. Four-corner arthrodesis--does the source of graft affect bony union rate? Iliac crest versus distal radius bone graft. J Plast Reconstr Aesthet Surg 2012; 65 (03) 379-383
- 19 Korus LJ, Ball B, Morhart M. Exclusion of the hamate in 4-corner fusion: technique and outcomes of a novel approach to intercarpal arthrodesis. Tech Hand Up Extrem Surg 2013; 17 (02) 102-105
- 20 Ozyurekoglu T, Turker T. Results of a method of 4-corner arthrodesis using headless compression screws. J Hand Surg Am 2012; 37 (03) 486-492
- 21 Tielemans A, Van Innis F, Troussel S, Detrembleur C, Libouton X, Lequint T. Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines. Hand Surg Rehabil 2017; 36 (03) 186-191
- 22 Vance MC, Hernandez JD, Didonna ML, Stern PJ. Complications and outcome of four-corner arthrodesis: circular plate fixation versus traditional techniques. J Hand Surg Am 2005; 30 (06) 1122-1127
- 23 Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 1995; 35 (01) 54-59
- 24 Kendall CB, Brown TR, Millon SJ, Rudisill Jr LE, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2005; 30 (05) 903-907
- 25 Trail IA, Murali R, Stanley JK. , et al. The long-term outcome of four-corner fusion. J Wrist Surg 2015; 4 (02) 128-133
- 26 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
- 27 Ho PC. Arthroscopic partial wrist fusion. Tech Hand Up Extrem Surg 2008; 12 (04) 242-265
- 28 del Piñal F, Klausmeyer M, Thams C, Moraleda E, Galindo C. Early experience with (dry) arthroscopic 4-corner arthrodesis: from a 4-hour operation to a tourniquet time. J Hand Surg Am 2012; 37 (11) 2389-2399
- 29 del Piñal F, García-Bernal FJ, Pisani D, Regalado J, Ayala H, Studer A. Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am 2007; 32 (01) 119-123
- 30 Hagert E, Garcia-Elias M, Forsgren S, Ljung BO. Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition. J Hand Surg Am 2007; 32 (01) 30-36
- 31 Baur EM. Arthroscopic-assisted partial wrist arthrodesis. Hand Clin 2017; 33 (04) 735-753
- 32 Tang JB. Re: levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 2009; 34 (01) 137-138
- 33 Iordache SD, Nam D, Paylan J, Axelord T. Four-corner arthrodesis using two headless compression screws. Acta Orthop Belg 2016; 82 (02) 332-338
- 34 Richards AA, Afifi AM, Moneim MS. Four-corner fusion and scaphoid excision using headless compression screws for SLAC and SNAC wrist deformities. Tech Hand Up Extrem Surg 2011; 15 (02) 99-103
- 35 Hernekamp JF, Reinecke A, Neubrech F, Bickert B, Kneser U, Kremer T. 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; 136 (04) 571-578
- 36 Koehler SM, Melone CP. Four-corner arthrodesis employing the native scaphoid as the principal donor graft for advanced collapse deformity of the wrist: technique and outcomes. J Hand Surg Eur Vol 2017; 42 (03) 246-252
- 37 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 Am 2008; 33 (05) 635-642
- 38 Shindle MK, Burton KJ, Weiland AJ, Domb BG, Wolfe SW. Complications of circular plate fixation for four-corner arthrodesis. J Hand Surg Eur Vol 2007; 32 (01) 50-53