Results of a Method of 4-Corner Arthrodesis Using Headless Compression Screws

Purpose To evaluate the functional and radiographic results of a scaphoid excision and four-corner arthrodesis technique using percutaneous headless compression screws. Methods A cohort of 33 patients, mean age 51 (range, 20-72) years, was treated for scapholunate advanced collapse (19), scaphoid nonunion advanced collapse (12), midcarpal instability (1), and Preiser disease (1). After scaphoid excision and removal of cartilage and subchondral bone in the midcarpal joint through a limited arthrotomy, capitolunate fixation was achieved with a percutaneous, transmetacarpal Acutrak screw (Acumed LLC, Hillsboro, OR), and triquetrohamate fixation was done with a percutaneous screw. Scaphoid was used as a bone graft. The average follow-up time was 8 months (n = 32; range, 6-64 mo). Results Union occurred in 31 of 33 wrists (94%). One of the 33 patients had total wrist arthrodesis. Average total active flexion-extension arc was 71 degrees after surgery and 83 before surgery. The postoperative carpal height averaged 0.47 compared to preoperative values of 0.45. The percentage of grip strength significantly improved from 41% before surgery to 80% after surgery. Postoperative mean verbal numerical rating scale pain score was less than 1, statistically better than the preoperative score of 7. Twenty-five of 33 patients were completely pain free. The average postoperative Mayo wrist score was 74, a significant improvement over the preoperative average of 40. Final Disabilities of the Arm, Shoulder, and Hand scores averaged 13 (n = 32; range, 0-49). Conclusions These results were comparable to or better than the results of previously published techniques in terms of fusion rates, alleviation of pain, grip strength, range of motion; Mayo wrist score; and Disabilities of the Arm, Shoulder, and Hand questionnaire score. The technique exploits the theoretical advantages of strong compression between carpals while avoiding a screw-head sized hole in the lunate articular cartilage and preserving the dorsal capsular ligament attachments to the triquetrum. (J Hand Surg 2012;37A:486-492. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.