Four-corner arthrodesis using distal radius bone grafting

Abstract

Purpose The aim of the study was to review the clinical and radiographic results of four-corner arthrodesis for stages 2 and 3 scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist using 3 Kirschner-wires (3K-wires) and bone graft from distal end of the radius. Patients and methods Twenty patients (scaphoid nonunion advanced collapse, n = 14; scapholunate dissociation, n = 6) underwent four-corner arthrodesis using 3K-wires and distal end radius bone graft and were evaluated for radiographic and clinical success using standard posteroanterior and lateral wrist radiographs and according to modified Mayo Wrist Scoring Chart at 6 and 12 months after surgery. Wrist pains, range of the wrist motion, and grip strength were evaluated at final follow-up. A total of 12 men and eight women were included and their average age at surgery was 38 years. In all, 14 wrists were right and six were left. Results Radiographic film assessment revealed union in all cases after an average period of 7 weeks, a well-preserved radiolunate articular interval at all stages of follow-up examination. Pain classification scores showed that 10 patients were pain free, nine patients complained slight pain with vigorous activities, and only one patient complained moderate pain with vigorous activities. The mean flexion improved from 42 to 70% of the normal side. The mean extension improved from 29 to 65% of the normal side. The mean ulnar deviation improved from 28 to 43% of the normal side. The mean radial deviation improved from 30 to 45% of the normal side. Grip strength significantly improved from 28% of opposite side preoperatively to 61% postoperatively. Complications occurred in three cases, radial impingement in one patient, ulnar neuritis in one patient, and superficial infection in one patient. Conclusion We have shown that four-corner arthrodesis using K-wires effectively achieves union, provides satisfactory pain relief, restores grip strength, allows return to original job, and preserves functional motion.