title: Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws.
abstract: BACKGROUND
  Four-corner fusion has been shown to be a reliable option of treatment of wrist arthritis, but there is no consensus about which implant and surgical procedure should be used in the arthrodesis. The present study aimed to describe a surgical technique using 2 crossed screws as implants, inserted in a retrograde manner, and to demonstrate preliminary results of the use of the technique.
  
  
  METHODS
  A retrospective study was conducted using medical records and imaging tests (radiographs and computed tomography) of all 15 patients who underwent a standardized 4-corner fusion technique, between December 2011 and July 2015, in the Department of Hand Surgery of Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, Brazil. We collected data on the following variables: fusion rate, time to fusion, and percentage of patients who had any complications or needed another surgical procedure on the same wrist.
  
  
  RESULTS
  All but one patient achieved fusion of arthrodesis. The average time to union was 5.54 months (SD = 3.84). Only the patient who developed nonunion of the 4-corner fusion required another surgery on the same wrist.
  
  
  CONCLUSIONS
  The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.
authors.affiliation: 1 Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil.
authors.forename: João
authors.initials: J
authors.lastname: Mamede
authors.affiliation: 1 Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil.
authors.forename: Sandro
authors.initials: S
authors.lastname: Castro Adeodato
authors.affiliation: 1 Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Aquino Leal
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D001863:Bone Screws; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D012189:Retrospective Studies; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: SLAC; SNAC; arthrodesis; four-corner fusion; hand surgery; screws; surgical technique