Four-corner arthrodesis using two headless compression screws

We present the outcome of four-corner wrist arthrodesis using two headless compression screws for fixation. The study group consisted of 27 patients who underwent arthrodesis from 1998 through 2007. Data on demographic parameters, diagnosis, range of motion, pain and complications were collected from the medical files. A total of 77 series of anteroposterior, oblique, and lateral x-rays were reviewed by three independent interpreters; consensus of at least two was required for the bones to be considered fused. Fusion was achieved in 24/27 wrists. Overall, inter-observer agreement in identifying radiographic bony fusion was fair (x = 0.41). At the critical timing, 86 (SD 68) days postoperatively, when the decision regarding fusion was made, inter-observer agreement was poor (x = 0.07). Our rates of fusion are consistent with reports in the literature. Radiographs performed at 3 months after four-corner arthrodesis are not reliable for the diagnosis of fusion.