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J Wrist Surg 2019; 08(03): 202-208
DOI: 10.1055/s-0039-1678673
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Aleksi Vihanto
1   Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
,
Tero Kotkansalo
1   Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
,
Markus Pääkkönen
1   Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
› Author Affiliations
Further Information

Publication History

29 April 2018

07 January 2019

Publication Date:
20 February 2019 (online)

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Abstract

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.

Keywords

four-corner arthrodesis - wrist arthroscopy - midcarpal joint - SLAC

Note

The research protocol was approved in advance by the hospital management through the Turku Clinical Research center.


 

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