Clinical outcomes of scaphoid and triquetral excision with capitolunate arthrodesis versus scaphoid excision and four-corner arthrodesis.
OBJECTIVE
To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthrodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis.


METHODS
We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strength; visual analog scale (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthroplasty, and pisotriquetral arthritis were recorded.


RESULTS
Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strength, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision.


CONCLUSIONS
Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strength, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the lunate following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concern with this technique.


METHODS
Therapeutic III.
Gaston
R Glenn
RG
OrthoCarolina, Charlotte, NC 28204, USA. glenngaston@hotmail.com
Greenberg
Jeffrey A
JA
Baltera
Robert M
RM
Mih
Alex
A
Hastings
Hill
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D001863:Bone Screws; D051224:Capitate Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D004185:Disability Evaluation; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D051225:Hamate Bone / Q000000981:diagnostic imaging / Q000601:surgery; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D051221:Triquetrum Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult