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. 2019 Jun;8(3):202-208.
doi: 10.1055/s-0039-1678673. Epub 2019 Feb 20.

The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Aleksi Vihanto  1 , Tero Kotkansalo  1 , Markus Pääkkönen  1
Affiliations

The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Aleksi Vihanto et al. J Wrist Surg. 2019 Jun.

Abstract

Background Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically. Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique. Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse ( n = 6), Preiser's disease ( n = 1), radioscaphoid ( n = 1), or capitolunar ( n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws. Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months. Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement. Level of Evidence This is a level IV, retrospective case series.

Keywords: SLAC; four-corner arthrodesis; midcarpal joint; wrist arthroscopy.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Arthroscopic portals 3–4, 6R, midcarpal radial and ulnar are created.
Fig. 2
Fig. 2
A 4.0 mm burr is used to remove the scaphoid and the articular surfaces of the midcarpal joint.
Fig. 3
Fig. 3
Operation times in chronological order.
Fig. 4
Fig. 4
( A , B ) X-rays of a patient operated early in the series. A sizable scaphoid remnant combined with radial wrist pain led to reoperation to remove the entire scaphoid.
Fig. 5
Fig. 5
An egg shell fragment of the distal tubercle often remains, since the arthroscopic removal of this fragment is extremely difficult. An inexperienced surgeon may cease the dissection prematurely leaving a sizeable scaphoid remnant. Radial wrist pain may occur postoperatively.
See this image and copyright information in PMC

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