Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws

Abstract

The procedure described in this study demonstrated a low complication rate and high fusion rate, and can therefore be considered a reliable surgical technique for 4-corner fusion.

Scaphoid Excision and Four Corner Fusion Using Anti-Grade Headless Compression Screws in the Management of Stage I and II SNAC Wrists

“…However, several modifications have been introduced to improve the outcome of using plate fixation in 4-CF with promising results. Using locked dorsal plates, recessed plates and radiolucent plates had improved the outcome of dorsal plate fixation [13,20,23,25] Several studies compared the outcome of 4-CF using conventional methods of fixation in comparison to the more expensive, more sophisticated locked dorsal plate; failed to prove the superiority of the plate fixation over conventional methods of fixation [13,25,26].…”

“…Thus, reducing the costs and using the minimal hardware to fix the bones, facilitated the imaging and the verification of state of the fusion. Increasing the number of the screws used in the fusion site increased the incidence of complications related to the prominence of the screws leading to irritation of the soft tissues that usually occurred with the dorsal plates where 8 screws were used for fixation [26].…”

“…The high rate of union in a relatively shorter time reported in our study could be attributed to the stable compression of the fusion site provided by the converging screws, adequate meticulous preparation of the fusion site and adequate graft harvested from the distal radius. The reported nonunion rate in the literature range from 0% to 63%, depending on the surgical technique and the method of fixation used [7,8,10,11,[25][26][27][28][29][30][31]33,34].…”

“…Sixteen patients (47.05%) in our study were followed up more than four years. The reported rates of conversion of 4-CF to total wrist fusion in the literature varies from 2.4% to 29% [11,26,27]. Trail et al in a long follow up study (9 years and 4 months (range 3-19 years)) reported that 6 out of 110 patients (5.5%) required total wrist fusion that was done within the first two years after the initial operation [36].…”

Artrodesis de cuatro esquinas: Análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica

“…Un patrón degenerativo similar se puede desarrollar en la no unión de escafoides y generar un colapso carpiano conocido como SNAC (scaphoid nonunion advanced collapse). 3,4 En ambos casos, la inestabilidad crónica del carpo genera un daño articular progresivo con mal alineamiento carpiano y en etapas sucesivas, conllevando al colapso avanzado del carpo y generando una panartrosis severa. 1,4,5 Se describen 4 etapas evolutivas donde en la etapa I se encuentra comprometida la estiloides radial.…”