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Surgery of the Wrist
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ramon Tahmassebi, Sirat Khan, Kalpesh R Vaghela
The ‘four-corner’ fusion (capitate–hamate–triquetrum–lunate fusion) is indicated in scapholunate advanced collapse (SLAC) wrist, scaphoid non-union advanced collapse (SNAC) wrist or mid-carpal instability. The procedure includes a scaphoidectomy and a fusion of the capitate, lunate, hamate and triquetrum. It is vital that the radiolunate joint remains in good condition and capable of function without pain. This should be carefully evaluated preoperatively either radiographically or using wrist arthroscopy. The landmarks, basic approach and structures at risk are similar to those of full wrist fusion.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Limited carpal fusion (LCF) – four-corner fusion – if the articular surface of the proximal lunate is intact, i.e. radiolunate changes exclude the use of LCF. This is often combined with scaphoid excision.
The wrist
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Proximal row carpectomy (PCR) or four-corner fusion (4CF) For advanced changes, surgery can help but wrist movement should be preserved if possible. The procedure depends upon the pattern of arthritis. Very often the radius–lunate joint is preserved, which allows either the entire proximal row of carpal bones to be removed (proximal row carpectomy – the head of the capitate then articulates on the lunate fossa of the radius) or scaphoid removal with four-corner fusion (the lunate–capitate–hamate–triquetrum are fused with wires, a circular plate or buried screws) (Figure 15.28).
Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Octavian Andronic, Raffael Labèr, Philipp Kriechling, Daniel Karczewski, Andreas Flury, Ladislav Nagy, Andreas Schweizer
Scaphoid excision and four-corner fusion (4CF) technique were developed for treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) [1], but has subsequently become a surgical option for other wrist conditions such as nondissociative carpal instability. Like its alternative treatment (proximal row carpectomy), the midcarpal arthrodesis has the purpose of achieving a stable joint, alleviate pain and preserve the range of motion (ROM) (through preserved articulation between lunate and distal radius) and strength [2,3]. Multiple fixation techniques are being inconsistently used, including: fixation with Kirschner wires [4,5], the use of headless screws [6–8], the placement of circular [7,9,10] or rectangular plates [11]. Reported fusion rates vary across literature with regard to the fixation technique and reports were inconsistent when trying to determine a superior method: some support compression screws [12], whilst other authors are favoring the usage of plate fixation [13,14].
Progressing arthrosis and a high conversion rate 11 (4–19) years after four corner fusion
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Ole Reigstad, Trygve Holm-Glad, Preben Dovland, Johanne Korslund, Christian Grimsgaard, Rasmus D. Thorkildsen, Magne Røkkum
Untreated scapholunate ligament injury or scaphoid non-union often lead to painful wrist arthrosis. Limited wrist arthrodesis or resections can reduce pain and preserve motion and function [1]. Four corner fusion (4CF), described by Watson and Ballet [2] or proximal row carpectomy (PRC), described by Stamm [3] are treatment alternatives. 4CF has a wider indication than PRC being a treatment option also in scaphoid non-union advanced collapse (SNAC 3) and scapho-lunate advanced collapse (SLAC 3) patients where the midcarpal joint is also affected. In Watson’s original description the scaphoid was replaced with a silicon implant, the implant was later abandoned due to complications [4]. Bone fusion in 4CF is achieved by different means including K-wire fixation, staples, headless compression screws and circular plates with screws [5]. The latter has demonstrated the highest non-union and hardware complication rate [6–8]. The clinical result after 4CFvaries considerably, ranging from no gain after surgery to satisfactory results; the majority report reduced motion, strength and pain scores [6,9]. Although numerous case series have demonstrated good clinical results, long-term follow is rarely reported. The aim of our study was to evaluate whether the good short to midterm results reported after 4CF surgery could be expected after longer term follow-up. We performed a retrospective follow-up of patients operated with 4CF due to SNAC and SLAC grade 2 or 3.
Two cases of pyrocarbon capitate resurfacing after comminuted fracture of the capitate bone
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Aleid C. J. Ruijs, Joël Rezzouk
Perilunate dislocation with fracture of the scaphoid and capitate is a rare but serious injury, leading in general to an important loss of function and early degenerative changes. In most cases, the treatment is emergency open reduction and fixation, but if there is a bony defect of the head of the capitate, a four-corner arthrodesis is performed. In four-corner fusion one can expect a grip strength and flexion and extension of 50%, comparable to our two cases, and 40% of radioulnar deviation where we had near normal results [5]. Pyrocarbon is a ceramic material, which has been used in the medical field since the 1960s. It was first used as prosthetic heart valves, then MCP and PIP joint implants and most recently wrist bone implants [6]. The July 2014 (J Hand Surg Eur. 2014; 39) issue of The Journal of Hand Surgery (European Volume) contains six full length articles, one editorial comment, one commentary, and one short report, all relevant to pyrocarbon and pyrolytic implant and prosthesis usage in the hand. The pyrocarbon RCPI prosthesis has been used for chronic degeneration of the wrist as in SNAC or SLAC wrist, in combination with a proximal row carpectomy [1,2]. In these cases, a four-corner fusion or capitolunate arthrodesis was not possible because of osteoarthritis of the radiocarpal joint. Another recent article compares the results of a proximal row carpectomy with RCPI implant (PRC-RCPI) and a four-corner arthrodesis (4CA) for advanced carpal arthritis [3]. The first group had 31 patients and the second group 26. Results were comparable between both groups. The RCPI prosthesis has also been used for resurfacing of the capitate head without adjacent proximal row carpectomy. Dereudre et al. [7], present a case in which an avascular necrosis of the capitate in a 30-year-old woman was successfully treated with a RCPI prosthesis. Although experiencing persistent decrease in range of motion, she had resumed her normal activities at 22 months’ follow-up. Another recent article describes two cases in which a chronic Fenton’s syndrome [8] was treated with the same prosthesis, giving a good outcome at 48 and 64 months’ follow-up respectively. A longer follow-up and more cases are needed to better assess the use of this prosthesis in comminuted fractures of the capitate. However, in this preliminary case report with a relatively short follow-up, the results are satisfactory and without complications. There were no complications due to the use of the external fixator or at the site of the bone graft (iliac crest). The use of a pyrocarbon capitate resurfacing in comminuted fractures of the capitate may be considered as a treatment alternative to a four-corner fusion [9]. In the case of failure, a secondary arthrodesis can still be performed.