Non-union scaphoid: Four-corner fusion of the wrist.
BACKGROUND
Four-corner fusion of the wrist is an option for management of non-union scaphoid with painful arthritis of the wrist. Various surgical techniques have been devised for four-corner fusion, with inconsistent results. We present our experience of four-corner fusion achieved using a standard H-plate, designed originally for anterior cervical plating.


METHODS
The study is a retrospective analysis of six cases of painful wrist arthritis resulting from nonunion of scaphoid treated by four-corner fusion, between 1996 and 2004. The average duration of follow-up was 5.8 years. Each patient was evaluated clinically according to the rating scales described by Bach.


RESULTS
The mean grip-strength calculated as a percentage of the uninvolved side was 47% pre-operatively, and 74% post- operatively at the final follow-up. The difference between the preoperative and postoperative 'pain ratings' and 'activity ratings' was found to be statistically significant (P<0.001). Mean time to fusion was 16.1 weeks. Dorsal impingement was the most common associated problem.


CONCLUSIONS
H-plate, used for four-corner fusion, provides rigid fixation, ensures fusion, and is a good alternative to the available options.
Gupta
Ravi K
RK
Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India.
Chauhan
Dalvir S
DS
Singh
Harmeet
H