Abstract
Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion,
has been introduced as an alternative to four-corner fusion. The rationale behind
this is obtaining less need for bone grafting and consequently improving the chances
of the union.
Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean
age of 58.4 years (range: 35–79), have been treated for scapholunate advanced collapse
or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed
as two-column fusion, and in 12 cases as one-column fusion. The union was determined
by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments
(visual analog score: 0–100), range of motion (ROM), grip strength, and Quick Disabilities
of the Arm, Shoulder, and Hand score were prospectively included.
Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range:
12–68). All patients but two achieved union at a mean of 9.5 weeks (range: 5–25 weeks).
Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively (p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean)
(not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5
(median) before the surgery to 11 (median) after the surgery (p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total
dorsovolar/radioulnar flexions, respectively. Three patients were converted to total
wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column
fusion, which united.
Conclusion One- and two-column fusion showed significant improvement in pain and function, with
minimal impairment of the grip strength on the short- to mid-term follow-up. A union
rate of 95% and an acceptable complication rate were achieved, without fusing all
carpals.
Level of Evidence Prospective, cohort study, level III.
Keywords
intercarpal fusion - lunocapitate fusion - two-column fusion - one-column fusion -
four-corner fusion - headless compression screws - wrist pain - SLAC - SNAC
