Four-corner arthrodesis employing the native scaphoid as the principal donor graft for advanced collapse deformity of the wrist: technique and outcomes.
The purpose of this study was to determine the functional, radiographic, and subjective outcome of the authors' technique of four-corner arthrodesis using the en bloc excised scaphoid as the principal donor bone graft coupled with Kirschner wire fixation. The study comprised 40 consecutive patients with progressive Stage II and III scapholunate advanced collapse or scaphoid nonunion advanced collapse deformities. Preoperative and postoperative range of motion, grip strength, carpal height, and Michigan Hand Outcomes Questionnaire responses were assessed with a mean follow-up of 4.4 years. At an average of 7 weeks, all patients demonstrated radiographic fusion. Moreover, postoperatively, improvement in the Michigan Hand Outcomes Questionnaire domains of overall function, activities of daily living, work performance, pain, and satisfaction were statistically significant. Complications were few and no patient required revision surgery. In this study, the authors' technique results in a reliable four-corner arthrodesis with a low expectation of complications or revision surgery.


METHODS
IV.
Department of Orthopaedic Surgery, Mount Sinai Beth Israel Hand Center, Mount Sinai Health System, New York, NY, USA.
S M
SM
Koehler
Department of Orthopaedic Surgery, Mount Sinai Beth Israel Hand Center, Mount Sinai Health System, New York, NY, USA.
C P
CP
Melone
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001174:Arthrodesis; D016025:Bone Transplantation; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery*; D014955:Wrist Joint; D055815:Young Adult
4CA; Four-corner arthrodesis; SLAC; SNAC; carpectomy; scaphoid bone graft