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Lunocapitate versus Four-Corner Arthrodesis Using Headless Compression Screws in Treatment of Scapholunate Advanced
Hong Swo Tan1, Philippe Massard-Combe2, Sara Sadat Farshidfar2
1Department of Orthopaedics, Norwest Private Hospital, Bella Vista, New South Wales, Australia.
Introduction:
Scapholunate advanced collapse and scaphoid nonunion advanced collapse are debilitating degenerative wrist conditions. Four-corner fusion (4CF) and lunocapitate fusion (LCF) are commonly used techniques, with headless compression screws (HCS) improving outcomes in recent years. However, few direct comparisons of 4CF and LCF using HCS exist. This systematic review and meta-analysis aim to address this knowledge gap.
Materials And Methods:
A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, Google Scholar, Medline, and Cochrane Library. Articles published between 2000 and 2023 were screened in adherence to PRIMSA guidelines. Data extraction focused on primary outcomes such as range of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores, as well as secondary outcomes like nonunion and reoperation rates. Pooled estimates for outcomes were calculated using random-effect meta-analyses to account for heterogeneity, with subgroup analyses and statistical significance evaluated at p < 0.05. Results were presented with confidence intervals and forest plots.
Results:
Seventeen studies with a total of 281 patients were included. Both techniques demonstrate comparable flexion-extension arcs (72.7 vs. 73.9 degrees), with LCF providing a nonsignificant trend toward better grip strength (39.56 vs. 22.87 kg) and lower DASH scores (11.65 vs. 17.44). However, LCF exhibits higher complication rates, including nonunion (9.15 vs. 3.91%) and reoperation (15.03 vs. 5.47%).
Conclusion:
Overall, both techniques provide comparable outcomes. The more anatomical arthrodesis provided by LCF may preserve function better, but it has a more significant complication profile and larger studies are required to investigate its utility over 4CF.
Level Of Evidence:
Therapeutic IV.
