title: Early experience with (dry) arthroscopic 4-corner arthrodesis: from a 4-hour operation to a tourniquet time.
abstract: OBJECTIVE
  Scaphoidectomy and 4-corner arthrodesis (4CA) is an effective procedure for treating several degenerative conditions of the wrist. Recently, the arthroscopic approach to this operation was described. Although it is conceptually appealing, certain aspects make its application difficult. We present our technique for dry arthroscopic scaphoidectomy and 4CA, which reduces the operative time to less than 2 hours.
  
  
  METHODS
  Four consecutive patients underwent scaphoidectomy and 4CA. In each case, we performed the operation with a dry arthroscopic technique using cannulated screws for rigid fixation. We performed bone grafting from the distal radius in 2 patients and from the scaphoid itself in the other two. The relevant operative details are the use of a scapholunate portal, the resection of the scaphoid with a pituitary rongeur, and the placement of bone graft in a dry arthroscopic environment. Range of motion exercises are started 2 to 3 weeks after the operation.
  
  
  RESULTS
  The first operation took 4 hours. The last 2 were completed in 1 hour 45 minutes and 1 hour 55 minutes, respectively. No complications occurred. No operations were converted to an open procedure.
  
  
  CONCLUSIONS
  Although the operation has a steep learning curve, it is conceptually appealing. It is too early to prove that the arthroscopic procedure has better results than the open 4CA; nevertheless, in our opinion it represents the future of wrist surgery.
authors.affiliation: Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa, Santander, Spain. drpinal@drpinal.com
authors.forename: Francisco
authors.initials: F
authors.lastname: del Piñal
authors.forename: Melissa
authors.initials: M
authors.lastname: Klausmeyer
authors.forename: Carlos
authors.initials: C
authors.lastname: Thams
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moraleda
authors.forename: Carlos
authors.initials: C
authors.lastname: Galindo
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D016025:Bone Transplantation; D059032:Learning Curve; D019637:Orthopedic Procedures / Q000379:methods*; D011884:Radius / Q000637:transplantation; D021361:Scaphoid Bone / Q000637:transplantation; D014955:Wrist Joint / Q000601:surgery*