title: Exclusion of the hamate in 4-corner fusion: technique and outcomes of a novel approach to intercarpal arthrodesis.
abstract: Scapholunate ligament disruptions and scaphoid nonunions are known to follow predictable patterns of arthritis. Advanced cases of such degenerative arthritis have traditionally been treated by either 4-corner fusion or proximal row carpectomy. Four-corner fusion has relied on the surface area provided by the capitate, lunate, triquetrum, and hamate to achieve a union. Earlier attempts in decreasing the involved surface area, that is, through fusion of only the capitolunate joint were not met with great success. With the advent of compression screws, however, we feel it is possible to achieve union while incorporating less surface area into the fusion block. We propose a novel procedure, the "2-corner, 3-carpal" fusion, which fuses only the capitate, lunate, and triquetrum, excluding the hamate. By taking advantage of compression screw technology we were able to achieve union and acceptable range of motion in 10 patients in our institution who underwent this procedure.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Alberta, Edmonton, AB, Canada.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Korus
authors.forename: Brandon
authors.initials: B
authors.lastname: Ball
authors.forename: Michael
authors.initials: M
authors.lastname: Morhart
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D002348:Carpal Bones / Q000601:surgery*; D050824:Carpal Joints / Q000601:surgery*; D005260:Female; D018737:Hand Strength; D006801:Humans; D012667:Lunate Bone; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome