Relationship Between Wrist Motion and Capitolunate Reduction in Four-Corner Arthrodesis

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Trauma Surgery

Background:

• Scaphoid nonunion and scapholunate advanced collapse (SLAC) are debilitating wrist conditions.
• Degenerative changes often accompany these conditions, necessitating surgical intervention.
• Circular plate fixation with bone grafting is a surgical option for these complex wrist pathologies.

Purpose of the Study:

• To evaluate the outcomes of circular plate fixation and bone grafting in patients with scaphoid nonunion and SLAC.
• To assess the incidence of complications, including dorsal impingement, nonunion, and hardware issues.
• To analyze the correlation between surgical reduction and functional wrist outcomes.

Main Methods:

• Retrospective study of 36 patients undergoing circular plate fixation and bone graft.
• Indications included SLAC, scaphoid nonunion advanced collapse (SNAC), and sequelae of perilunate dislocation.
• Functional outcomes measured included pain (VAS), range of motion, grip strength, DASH score, and union rates.

Main Results:

• 35 of 36 patients achieved union within 6 months.
• Significant reduction in pain (VAS 7 to 1) and improvement in grip strength (34 kg to 50 kg).
• Hardware complications: 8.3% broken screws, 16.6% dorsal impingement; 70% overall patient satisfaction.

Conclusions:

• Circular plate fixation with bone grafting is an effective treatment for scaphoid nonunion and SLAC, leading to high union rates and improved function.
• While effective, potential hardware-related complications should be considered.
• Further research may explore optimizing surgical technique to minimize hardware issues and improve functional outcomes.