Scaphoid excision and 4-corner fusion using retrograde headless compression screws

• Published in: Techniques in hand & upper extremity surgery Vol. 16; no. 4; p. 204
• Main Authors: Ball, Brandon, Bergman, Joseph W
• Format: Journal Article
• Language: English
• Published: United States 01.12.2012
• Subjects: Arthrodesis - instrumentation; Arthrodesis - methods; Bone Screws; Carpal Bones - diagnostic imaging; Humans; Joint Instability - surgery; Ligaments, Articular - surgery; Radiography; Scaphoid Bone - surgery
• ISSN: 1531-6572
• DOI: 10.1097/BTH.0b013e3182688c6a

Scapholunate advanced collapse is a predictable form of wrist arthritis resulting from longstanding scapholunate instability. Four-corner fusion and scaphoid excision is a reliable procedure used to treat scapholunate advanced collapse wrist that improves pain and preserves range of motion. Multiple methods of achieving fixation have been described for the procedure including K-wires, staples, and headless compression screws. In previously described techniques, the compression screws are inserted in an antegrade manner, breaching the articular surface of the lunate. Even small areas of chondral damage may undermine the long-term durability of the radiocarpal joint. Given the 4-corner fusion relies on the integrity of the radiolunate articulation for success, it would seem advantageous to preserve the articular cartilage of the lunate. The technique described here involves retrograde insertion of headless compression screws to achieve a 4-corner fusion. Although it is still early, we anticipate that this procedure will result in similar fusion rates to other forms of fixation.