Functional Results of Four-Corner Arthrodesis using Multiple Headless Compression Screws

Journal of the Korean Society for Surgery of the Hand 2008;13(4):247-252.
Published online December 1, 2008.

Sung-Cheol Yang, Joo-Yup Lee, Joo-Hyoun Song, Jae-Young Kwon

압박 금속 나사를 이용한 사중관절 유합술

양성철, 이주엽, 송주현, 권재영

Abstract

Purpose
We present the functional results of fourcorner arthrodesis using multiple headless compression screws for treatment of scaphoid nonunion advanced collapse (SNAC) wrists. Materials and Methods: Seven patients who had SNAC wrist were treated with four-corner arthrodesis using headless compression screws. There were 6 men and 1 woman. The mean age of the patients was 43.7 years (range, 32-59). The mean follow-up was 19 months. Through the dorsal incision, scaphoid fragments were excised and capito-lunate, luno-triquetral, capitohamato-triquetral joints were fixed with three headless compression screws after decortication. Postoperative results were assessed using VAS pain score, range of motion, grip strength, and Korean DASH disability score. Results: Average time to union was 8 weeks (range 6-12). There was no nonunion or dorsal impingement. The capitolunate angle was increased from -16.7 degrees to 19.2 degrees. VAS pain score decreased from 7.6 to 2.5. Mean wrist extension motion was 41.7¡¾6.7 degrees and wrist flexion motion was 27.5¡¾5.7 degrees. Grip strength was 77.3¡¾9.5% of normal side. Mean DASH disability score was 32 (range 18-40). Conclusion: Multiple headless compression screw fixation technique can be a reasonable alternative for fourcorner arthrodesis without nonunion or dorsal impingement.