Four corner arthrodesis involves excision of scaphoid and fusion of the remaining wrist bones in neutral alignment. It is motion preserving limited arthrodesis and provides pain relief and improved grip strength.
This four corner arthrodesis is based on the principle that the radiolunate articulation is often spared from degenerative changes from conditions.
- SLAC wrist
- Chronic dynamic carpal instability
- Chronic perilunar instability not amenable to soft tissue surgery
- Ulnar Translocation
- Radiolunate arthritis
The joint capsule is opened individual carpal articulations are exposed. The scaphoid is identified and excised in most of the cases.
Reduction of the collapse deformity to realign the midcarpal joint is critical to the success of the procedure. The lunotriquetral relationship is reduced and secured with Kirschner wires.
The fusion surfaces between the lunate, capitate, hamate, and triquetrum are then denuded down to cancellous bone..
After surgery, patients are placed in a compressive dressing with an internal short arm splint. Digital motion is encouraged immediately after the effect of anesthesia wanes off.
At 10 to 14 days postoperatively, a short arm cast is applied in those individuals treated with pins alone. These are typically removed at approximately 8 weeks postoperatively, at which time therapy is begun.
Following complications have been reported with four corner arthrodesis.
- The most common complication after four-corner fusion is dorsal radiocarpal impingement in wrist extension. This occurs secondary to inadequate reduction of the capitolunate relationship
- Reflex sympathetic dystrophy
- DeQuervain’s tenosynovitis
Non union is very rare in four corner arthrodesis. There is a reported failure rate of 2%.
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