Background Long term follow up studies of scaphoid nonunion have shown that radio-scaphoid arthritis followed by midcarpal instability and advanced collapse will eventually follow untreated scaphoid fractures nonunion. Four-corner fusion of the midcarpal joint (lunate, triquetrum, capitate, and hamate) is a motion preserving limited wrist arthrodesis aiming to achieve a painless and stable wrist joint.
Patients and methods: Between May 2011 and October 2013, 18 patients with scaphoid nonunion were enrolled in the current study. Inclusion criteria included patients with scaphoid nonunion advanced collapse grade II and III. Exclusion criteria include cases with radio-lunate arthritis and cases with wrist stiffness. All patients were evaluated clinically and Radiologically by x-rays and CT scans to assure normal radio-lunate articulation. All patients were operated by using H-shaped miniplates and screws.
Result: Radiographs of the wrist showed complete fusion in mean average 7weeks (range 6 to 10 weeks). All the 7 patients with office based work returned to their previous activity level, and only 8 of the 11 manual workers could return to their previous jobs with the remaining 3 couldn’t return to manual work.
Conclusion: Four corner fusion using H-shaped mini-plates and screws is effective in management of SNAC lesion with early mobilization and subsequent low stiffness and osteopenia rates. |
