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Scaphoid Excision and Bicolumnar Carpal Fusion with Retrograde Headless Screws
Background/Purpose Scaphoid excision and partial wrist fusion is used for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis. The purpose of this study was to report midterm functional and radiographic outcomes in a series of patients who underwent bicolumnar fusion of the lunocapitate and triquetrohamate joints using retrograde headless screws.
Methods Twenty-three consecutive patients (25 wrists) underwent surgery with this technique from January 2014 to May 2017 with a minimum follow-up of 1 year. Assessment consisted of range of motion, grip, and pinch strength. Patient-reported outcome measures included disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores. Fusion rates and the radiolunate joint were evaluated radiographically. The relationship between wrist range of motion and midcarpal fusion angle (neutral position vs. extended capitolunate fusion angle > 20 degrees) was analyzed.
Results Average follow-up was 18 months. Mean wrist extension was 41 degrees, flexion 36 degrees, and radial-ulnar deviation arc was 43 degrees. Grip strength was 39 kg and pinch 9 kg. Residual pain for activities of daily living was 1.6 (visual analog scale). The mean DASH and PRWE scores were 19 ± 16 and 28 ± 18, respectively. Patients with an extended capitolunate fusion angle trended toward more wrist extension but this did not reach statistical significance (p = 0.17).
Conclusions With retrograde headless compression screws, the proximal articular surface of the lunate is not violated, preserving the residual load-bearing articulation. Patients maintained a functional flexion–extension arc of motion with grip-pinch strength close to normal. Capitolunate fusion angle greater than 20 degrees may provide more wrist extension but further studies are needed to demonstrate this.
Level of Evidence This is a Level IV study.
The study has obtained institutional ethics review board approval.
This research was conducted in Ottawa, Ontario, Canada at The Ottawa Hospital, Civic Campus (affiliated with the University of Ottawa)
Received: 14 April 2020
Accepted: 02 November 2020
Article published online:
20 January 2021
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- 1 Mahmoud M, El Shafie S. Bicolumnar fusion for scaphoid nonunion advanced collapse without bone grafting. Tech Hand Up Extrem Surg 2012; 16 (02) 80-85
- 2 Shintani K, Kazuki K, Takamatsu K, Yoneda M, Uemura T. Limited wrist arthrodesis for scapholunate advanced collapse wrist: triangle fixation for four-corner fusion. J Hand Surg Asian Pac Vol 2016; 21 (02) 207-211
- 3 Chaudhry T, Spiteri M, Power D, Brewster M. Four corner fusion using a multidirectional angular stable locking plate. World J Orthop 2016; 7 (08) 501-506
- 4 Yao YC, Wang JP, Huang TF, Chang MC, Huang YC. Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist. J Chin Med Assoc 2017; 80 (02) 117-120
- 5 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
- 6 Ferreres A, Garcia-Elias M, Plaza R. Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists. J Hand Surg Eur Vol 2009; 34 (05) 603-608
- 7 Enna M, Hoepfner P, Weiss AP. Scaphoid excision with four-corner fusion. Hand Clin 2005; 21 (04) 531-538
- 8 Wall LB, Didonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: minimum 20-year follow-up. J Hand Surg Am 2013; 38 (08) 1498-1504
- 9 Trail IA, Murali R, Stanley JK. et al. The long-term outcome of four-corner fusion. J Wrist Surg 2015; 4 (02) 128-133
- 10 Le Corre A, Ardouin L, Loubersac T, Gaisne E, Bellemère P. Retrospective study of two fixation methods for 4-corner fusion: shape-memory staple vs. dorsal circular plate. Chir Main 2015; 34 (06) 300-306
- 11 Delattre O, Goulon G, Vogels J, Wavreille G, Lasnier A. Three-corner arthrodesis with scaphoid and triquetrum excision for wrist arthritis. J Hand Surg Am 2015; 40 (11) 2176-2182
- 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 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
- 14 Ball B, Bergman JW. Scaphoid excision and 4-corner fusion using retrograde headless compression screws. Tech Hand Up Extrem Surg 2012; 16 (04) 204-209
- 15 Draeger RW, Bynum Jr DK, Schaffer A, Patterson JM. Bicolumnar intercarpal arthrodesis: minimum 2-year follow-up. J Hand Surg Am 2014; 39 (05) 888-894
- 16 Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985; 10 (01) 39-46