title: Limited Wrist Arthrodesis for Scapholunate Advanced Collapse Wrist: Triangle Fixation for Four-Corner Fusion.
abstract: Limited wrist arthrodesis with scaphoid excision is a useful treatment for scapholunate advanced collapse (SLAC) of the wrist. Multiple Kirschner wires were originally used for internal fixation of the four carpal bones, however long-term cast immobilization, pin tract infection, and hardware removal are still problematic. We introduce and evaluate the clinical outcomes of an internal fixation technique; triangle fixation for four-corner fusion, using three headless screws, as an alternative to conventional multiple Kirschner wires for the treatment of SLAC wrist.
  
  
  
  Five male patients with SLAC wrist secondary to three scaphoid nonunions and two scapholunate dissociations were treated with four-corner fusion using triangle fixation with three Double-threaded Japan screws. The mean age was 59.5 years (35-79 years) and the mean follow-up period was 40 months. After surgery, short arm splints were applied for 3-4 weeks, and then range of motion exercises were initiated.
  
  
  
  Wrist range of motion and grip strength both improved postoperatively. At the final follow-up evaluation, bone union was completely achieved and satisfactory pain relief was observed in all patients.
  
  
  
  Compared with the conventional Kirschner wire technique, the present technique shortens the period of splint immobilization due to a strong compression force in a skewed position, does not require pin removal or cause pin tract infections, and provides satisfactory results.
authors.affiliation: 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.|2 Department of Orthopedic Surgery, Osaka City General Hospital, Osaka, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Shintani
authors.affiliation: 3 Gakuen-minami Clinic, Nara, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kazuki
authors.affiliation: 4 Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan.
authors.forename: Kiyohito
authors.initials: K
authors.lastname: Takamatsu
authors.affiliation: 5 Department of Orthopaedic Surgery, Ekisaikai Hospital, Osaka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoneda
authors.affiliation: 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Uemura
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods*; D001864:Bone Wires; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000601:surgery*; D013165:Splints; D013997:Time Factors; D014953:Wrist; D014954:Wrist Injuries / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*
keywords: Double-Threaded Japan screw; Four-corner fusion; Scapholunate advanced collapse; Wrist arthrodesis