Four-Corner Arthrodesis Using a Circular Plate and Distal Radius Bone Grafting: A Consecutive Case Series

Abstract

Four-corner arthrodesis with scaphoid excision has been shown to be an acceptable method for treating wrist degenerative changes. Some recent studies have identified higher complication rates when circular plates are used. This study examined a consecutive case series with defined technique for outcome and complications. A retrospective assessment was performed in a consecutive cohort of 28 patients who underwent a standardized 4-corner arthrodesis with a 2nd-generation circular plate and distal radius bone grafting for a diagnosis of scapholunate advanced collapse, scaphoid nonunion advanced collapse, or midcarpal arthrosis. Complete data were obtained for 26 of the patients and partial data for the other 2. Follow-up examination included visual analog scale and activity scores, work status, posteroanterior and lateral radiographs, bone union status, grip strength, range of motion, and complications. Average follow-up was 46 months. Range of motion averaged 45% of the uninjured side (average extension, 35 degrees; average flexion, 26 degrees). Grip strength averaged 82% of the uninjured side. The mean visual analog scale pain and activity scores were 2.3/10 and 2.4/10. Only 1 patient required job modification because of wrist impairment. Radiographs demonstrated union of the primary capitolunate fusion mass in all of the cases. There was 1 case of probable but not certain peritriquetral nonunion and 1 case of asymptomatic loss of radiolunate joint space; in terms of hardware, there was screw back-out (of 1 screw) in 1 case the plate broke in 1 case. Two patients underwent reoperation, one for radial styloid impingement pain and the other for lack of flexion. Despite recent reports indicating a high nonunion rate with plate fixation, standardized 4-corner arthrodesis using a recessed, dorsal circular plate and distal radius bone grafting produced excellent and reproducible results in this consecutive series. Notably, there was no development of secondary arthritic changes at the radiolunate joint, indicating a reasonable durability to the procedure. Optimal results require exacting technique with quality bone graft.