Four-Corner Fusion Technique in Two Cases of Acute Perilunate Injury 4C Arthrodesis in Acute Perilunate

Abstract

Background

An osteochondral lesion at the level of the capitate head in perilunate dislocation (PLD) may worsen the patient's overall prognosis. This case report presents two cases of scaphoid excision and four-corner fusion (4CF) for acute PLD injury with severe osteochondral lesion at the level of the head of the capitate.

Case Description

The first case involved a 41-year-old man with a dorsal PLD, an associated ulnar styloid fracture and a highly comminuted radial styloid fracture involving the scaphoid facet of the radius. The second case involved a 35-year-old-man with a dorsal PLD on a previously unknown scaphoid nonunion (scaphoid nonunion advanced collapse [SNAC] stage 1). Both patients underwent scaphoid excision and 4CF with Kirschner wire fixation. At last follow-up (6 and 31 months, respectively), both patients had slight pain, had a functional range of motion, and achieved satisfactory functional outcomes. Radiographs confirmed 4CF union. No complications were reported.

Literature Review

Only two other cases of scaphoid excision and 4CF for acute PLD with osteochondral lesion at the capitate head have been reported, with minimal information on clinical outcomes.

Clinical Relevance

This article reports two cases of acute PLD with severe osteochondral lesions at the level of the head of the capitate, accompanied by poor local conditions (SNAC stage 1 or a comminuted scaphoid facet of the radius). It highlights the interest of scaphoid excision and 4CF in the acute setting with favorable short-term outcomes, where traditional open reduction and internal fixation or carpal row carpectomy would have been unreliable.

Keywords

perilunate - four-corner fusion - four-corner arthrodesis

Publication History

Received: 01 April 2025

Accepted: 20 June 2025

Article published online:
08 July 2025

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