Bicolumnar intercarpal arthrodesis: minimum 2-year follow-up

Area of Science:

• Orthopedic surgery
• Hand and wrist surgery
• Arthrodesis techniques

Background:

• Scaphoid excision is a common treatment for wrist conditions.
• Traditional 4-corner arthrodesis has known outcomes and limitations.
• Novel arthrodesis techniques aim to improve functional recovery and preserve joint mechanics.

Purpose of the Study:

• To evaluate the long-term (greater than 2-year) outcomes of combined lunate-capitate and triquetrum-hamate arthrodeses (bicolumnar arthrodesis) following scaphoid excision.
• To compare these outcomes with traditional scaphoid excision and 4-corner arthrodesis.
• To assess functional recovery, radiographic union, and complications.

Main Methods:

• Retrospective review of 16 patients undergoing scaphoid excision and bicolumnar arthrodesis (2007-2010).
• Follow-up evaluation of 11 patients including range of motion, grip strength, patient-reported outcomes, and pain assessment.
• Radiographic assessment for union and complications such as nonunion and hardware migration.

Main Results:

• Operative wrist flexion-extension was 68% of the contralateral wrist; grip strength was 97%.
• All 11 patients achieved radiographic bicolumnar union; 8 showed spontaneous capitohamate fusion.
• One patient required hardware removal due to migration despite union.

Conclusions:

• Bicolumnar arthrodesis following scaphoid excision yields outcomes comparable to 4-corner arthrodesis, with similar motion loss but potentially better grip strength.
• This technique preserves normal radiocarpal and midcarpal anatomical relationships.
• The simplified surgical technique offers an advantageous alternative for wrist reconstruction.