The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Background  Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically. Purpose  This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique. Patients and Methods  We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse ( n  = 6), Preiser's disease ( n  = 1), radioscaphoid ( n  = 1), or capitolunar ( n  = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws. Results  Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months. Conclusion  The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement. Level of Evidence  This is a level IV, retrospective case series.