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. |
