Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients

Abstract

Four-corner fusion is a rational surgical option for the management of degenerative conditions of the wrist. Most related studies have compared four-corner fusion with scaphoid excision or proximal row carpectomy, with a variety of reported results. To enhance the literature, we performed this study to evaluate a series of patients with degenerative conditions of the wrist treated with four-corner fusion using 3 surgical techniques and to discuss the clinical and radiographic outcome of the patients. We retrospectively studied 31 patients (24 men, 7 women; mean age, 43years; 9 heavy manual laborers) who underwent four-corner fusion of their wrists for degenerative conditions from 2005 to 2015. Internal fixation was done using multiple Kirschner wires (14 patients), headless compressive screws (8 patients), or a circular plate (9 patients). Mean follow-up was 4years (1-11years). We evaluated the clinical outcome with the Patient-Rated Wrist Evaluation (PRWE) score and fusion with radiographs. All patients experienced improvement of their pain, function, range of motion and grip strength (p<0.05). Twenty-three patients (74%) reported no pain, and eight patients reported mild, occasional pain. Twenty-one patients (68%) were able to do usual and specific activities. Mean wrist motion improved to 70% and mean grip strength improved to 85% of opposite wrist. Two heavy manual labor patients requested a job modification because of wrist impairment. Radiographs of the wrist showed fusion of all fused joints in 28 (90.3%) patients and partial fusion in three patients (9.7%). No patient with partial fusion required a reoperation for symptomatic nonunion until the period of this study. Three patients experienced complications (10%). Two patients treated with a circular plate experienced complex regional pain syndrome and painful implant impingement; another patient treated with Kirschner wires and headless compression screws experienced radiolunate arthritis from impingement of the lunate screw to the radius. Four-corner fusion is a reliable limited wrist fusion technique that provides pain relief, grip strength and satisfactory range of motion in patients with degenerative conditions of the wrist. Partial union is more common with Kirschner wire fixation and complications are more common with circular plate fixation.