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. 2021 Feb 24:24:102-110.
doi: 10.1016/j.jor.2021.02.032. eCollection 2021 Mar-Apr.

The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study

Stacy Fan  1 , Clare Padmore  2 , Assaf Kadar  3   4 , Spencer Chambers  1 , G Daniel G Langohr  2 , Nina Suh  1   2   3
Affiliations

The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study

Stacy Fan et al. J Orthop. .

Abstract

Purpose: To compare changes in wrist kinematics after scaphoidectomy and four-corner fusion (4CF), and proximal row carpectomy (PRC).

Methods: Six cadaveric specimens underwent flexion-extension, radial-ulnar deviation and circumduction in an active motion wrist simulator. Native state, "anatomic 4CF", "radial 4CF", and PRC were compared.

Results: Radial 4CF reduced wrist extension, while PRC reduced radial deviation. Fusion groups had similar motion profiles. 44%, 41%, and 32% of native circumduction was maintained in PRC, anatomic, and radial 4CF.

Conclusions: Both fusion positions resulted in comparable motion outcomes. Anatomic 4CF was restricted in wrist extension compared to PRC but provided favourable radial deviation.

Keywords: Circumduction; Four corner fusion; Partial wrist arthrodesis; Proximal row carpectomy.

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Figures

Fig. 1
Fig. 1
Four corner fusion was performed with five retrograde K-wires. capitolunate joint, triquetrohamate joint, and lunotriquetral joint. Biplanar fluoroscopic images were obtained to confirm the position of the wires and the two 2.7 mm lunate tracking screws.
Fig. 2
Fig. 2
Clinical visualization of A) Anatomic 4CF and B) Radial-aligned 4CF.
Fig. 2
Fig. 2
Clinical visualization of A) Anatomic 4CF and B) Radial-aligned 4CF.
Fig. 3
Fig. 3
Mean absolute change (°) in wrist flexion, extension, ulnar and radial deviation compared to native state. Asterisk indicates statistical significance (p < 0.05) between comparison groups. Asterisk at base illustrates significance compared to native state.
Fig. 4
Fig. 4
Total circumduction area (mm2). Asterisk indicates statistical significance (p < 0.05).
Fig. 5
Fig. 5
Circumduction pattern after anatomic 4CF (A), radial 4CF (B) and PRC (C), superimposed on native circumduction pattern.
Fig. 5
Fig. 5
Circumduction pattern after anatomic 4CF (A), radial 4CF (B) and PRC (C), superimposed on native circumduction pattern.
Fig. 5
Fig. 5
Circumduction pattern after anatomic 4CF (A), radial 4CF (B) and PRC (C), superimposed on native circumduction pattern.
Fig. 5
Fig. 5
Circumduction pattern after anatomic 4CF (A), radial 4CF (B) and PRC (C), superimposed on native circumduction pattern.
Fig. 6
Fig. 6
Percent of maintained motion within each quadrant compared to native state.
See this image and copyright information in PMC

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