Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist

Abstract

Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35–79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0–100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12–68). All patients but two achieved union at a mean of 9.5 weeks (range: 5–25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively (p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery (p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of evidence: Prospective, cohort study, level III.

Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years

“…The same arguments do not hold up compared to the LCF, as these procedures are technically simpler to perform, needing less hardware and using a joint capsule-sparing approach. Thus, the LCF surgical methods are less invasive than the 4CF, have fewer complications, resulting in a high union rate and better mobility [ 6 , 13 , 21 , 22 ]. Even though the LCF is a simpler procedure than the 4CF, the PRC is the simplest surgical procedure of these.…”

“…The luno-triquetral and triquetro-hamate joint spaces are assessed perioperatively and arthrodesis between hamate and triquetrum is performed in the same way, if necessary. The joint spaces are left untreated if normal cartilage is identified, and if the stability of the triquetro-hamate joint could be confirmed intraoperatively, the fixation of this joint is not needed [ 13 ]. However, the presence of the lunate type 2 might lead to nonunion or postoperative pain [ 15 ].…”

“…However, the presence of the lunate type 2 might lead to nonunion or postoperative pain [ 15 ]. Lunate type 2 was present in six out of 45 patients of this group and was usually treated by the removal of the triquetrum [ 13 ]. If necessary, radial styloidectomy might be added to the procedure to enhance the radial movement.…”

“…Comparative studies between PRC and LCF are lacking in the literature. Since the LCF procedures are less invasive [ 13 ], there is a knowledge gap if the LCF-treated patients operated on with headless compression screws could perform better than traditional 4CF patients, in comparison with PRC-treated patients.…”

Limited Intercarpal Fusion vs. Proximal Row Carpectomy in the treatment of SLAC or SNAC Wrist, results after 3.5 years.

“…The luno-triquetral and triquetro-hamate joint spaces are assessed perioperatively and arthrodesis between hamate and triquetrum is performed in the same way, if necessary. The joint spaces are left untreated if normal cartilage is identi ed [13]. Finally, the joint capsule is closed with Ethibond 4 − 0 sutures (Ethicon, Somerville, NJ, USA), and the skin is closed with Nylon 4 − 0 (Ethicon, Somerville, NJ, USA).…”