Rudnick B, Goljan P, Pruzansky J, Bachoura A, Jacoby S, Rekant M

The Journal of Hand Surgery, 34(8), 1407-1412, October 2009

Purpose: To compare the clinical outcomes of scaphoid and triquetral excision combined with capitolunate arthodesis versus 4-corner (capitate, hamate, lunate, triquetrum) intercarpal arthrodesis.

Methods: We retrospectively identified 50 patients with scapholunate advanced collapse wrist changes who had 4-corner arthrodesis. Thirty-four patients were able to return and complete all follow-up evaluations. Patient demographics were similar between the 2 groups. Follow-up evaluation included radiographs, wrist range of motion (flexion-extension, radial-ulnar deviation, and pronation-supination); grip strenght;visual analog scare (VAS); and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Complications of nonunion, hardware migration, conversion to wrist arthrodesis or arthoplasty, and pisotriquetral arthritis were recorded.

Results: Sixteen patients had capitolunate arthrodesis, and 18 patients had a 4-corner arthrodesis. There was no statistical difference in radial-ulnar deviation, pronation-supination, grip strenght, VAS, or DASH scores between groups. There was a slight increase in flexion-extension in the 4-corner group. There were 2 nonunions in the 4-corner group and none in the capitolunate group. Five patients in the capitolunate group required screw removal secondary to migration. Three patients in the 4-corner group required a subsequent pisiform excision.

Conclusions: Capitolunate arthrodesis compared favorably to 4-corner arthrodesis at an average 3-year follow-up in this series with respect to range of motion, grip strengh, DASH scores, and VAS. Advantages of capitolunate arthrodesis include a lessened need for bone graft harvesting while maintaining a similarly low nonunion rate, easier reduction of the luante following triquetral excision, and avoiding subsequent symptomatic pisotriquetral arthritis. Screw migration, however, remains a concerns with this technique.

Type of study / level of evidence: Therapeutic III.