Capitolunate arthrodesis versus four-corner fusion for advanced wrist collapse: a systematic review and meta-analysis

Capitolunate fusion (CLF) has been proposed as a viable alternative to other motion-preserving techniques such as three-corner fusion (3CF) and four-corner fusion (4CF) for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). This study systematically reviewed the literature comparing clinical outcomes and complication profiles of CLF versus 4CF; a small number of three-corner fusion cases were included.

The PubMed, EMBASE, and Web of Science databases were systematically searched for articles published between 1990 and 2025. Two independent authors performed blinded screening of titles and abstracts, followed by blinded full-text review. Outcomes of interest included the visual analog scale (VAS) score, Patient-Rated Wrist Evaluation (PRWE), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, reoperation rate, adverse events, and range of motion.

Seven studies were included, consisting of six retrospective cohort studies and one randomized controlled trial, encompassing a total of 320 patients. The VAS score demonstrated a borderline non-significant standardized mean difference of 0.34 (95% confidence interval: - 0.004 to 0.69; p = 0.053) in favor of four corner fusion. No statistically significant differences were observed between CLF and 4CF for PRWE, DASH score, range of motion, overall complication rate, reoperation rate, or nonunion rate. Only seven patients underwent three-corner fusion, precluding subgroup-specific analysis.

Compared with four-corner fusion, capitolunate fusion yields comparable patient-rated outcome measures, strength, motion, and complication profiles. Higher-quality prospective studies are required to further validate these findings.

Therapeutic study.