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Management of the scaphoid during four-corner fusion-a cadaveric study
Paul E Kobza1, Jeffrey E Budoff, Ming Long Yeh
1Department of Orthopaedic Surgery, Baylor College of Medicine and the Houston Veteran's Affairs Medical Center, Houston, TX, USA.
Purpose:
To examine the effects of scaphoid retention, inclusion, and excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner fusion with rigid internal fixation.
Methods:
Seven fresh-frozen cadaveric upper extremities were examined. For all surgical manipulations the motion was measured and contact characteristics were assessed using ultra-low prescale pressure-sensitive film.
Results:
Compared with the intact specimen, simple 4-corner fusion with scaphoid retention led to a significant decrease in extension, radial deviation, and ulnar deviation, but no change in radiolunate contact characteristics. After 4-corner fusion there was no significant difference in motion or radiolunate contact characteristics between scaphoid retention and scaphoid inclusion. After 4-corner fusion scaphoid excision allowed significantly greater radial deviation compared with scaphoid retention and scaphoid inclusion. Compared with the intact specimen 4-corner fusion with scaphoid excision also led to a significant increase in radiolunate contact area and mean contact pressure.
Conclusions:
When performing 4-corner arthrodesis in the absence of radioscaphoid arthritis, scaphoid excision may improve motion at the cost of increased mean radiolunate contact pressure.
