Non-union scaphoid: Four-corner fusion of the wrist

Background: Four-corner fusion of the wrist is an option for management of non-union scaphoid with painful arthritis of the wrist. Various surgical techniques have been devised for four-corner fusion, with inconsistent results. We present our experience of four-corner fusion achieved using a standard H-plate, designed originally for anterior cervical plating. Materials and Methods: The study is a retrospective analysis of six cases of painful wrist arthritis resulting from nonunion of scaphoid treated by four-corner fusion, between 1996 and 2004. The average duration of follow-up was 5.8 years. Each patient was evaluated clinically according to the rating scales described by Bach. Results: The mean grip-strength calculated as a percentage of the uninvolved side was 47 pre-operatively, and 74 post-operatively at the final follow-up. The difference between the preoperative and postoperative pain ratings and activity ratings was found to be statistically significant (P 0.001). Mean time to fusion was 16.1 weeks. Dorsal impingement was the most common associated problem. Conclusions: H-plate, used for four-corner fusion, provides rigid fixation, ensures fusion, and is a good alternative to the available options.