Two-Column Intercarpal Arthrodesis Using Headless Compression Screws

Two-column midcarpal arthrodesis (2CMA) after scaphoidectomy is a well-established procedure for treating advanced wrist arthritis, particularly scapholunate advanced collapse and scaphoid nonunion advanced collapse grade III wrists. This study evaluates the clinical and radiographic outcomes of 2CMA using headless compression screws (HCS) over a 21-year period.

From 2001 to 2022, 128 patients underwent 2CMA at two institutions. Preoperative arthroscopy was performed to confirm the integrity of the radiolunate joint. Outcomes were assessed using the Modified Mayo Wrist Score (MMWS), Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, Patient-Reported Wrist Evaluation (PRWE), and radiographic analysis. Statistical analyses were conducted to compare pre- and postoperative outcomes.

At a mean follow-up of 45 months, patients demonstrated significant improvements in pain (Visual Analogue Scale at rest: 2.0-0.6; under stress: 8.0-2.0; p  < 0.001) and functional scores (MMWS: 27-69; DASH: 73-37; PRWE: 79-26; p  < 0.001). Wrist range of motion improved from 61 to 81 degrees ( p  < 0.001), and grip strength increased from 19 to 28 kg (58-83% of the contralateral side, p  < 0.05). Radiographic bone fusion was confirmed in 99% of cases, with a low complication rate of 4%, including two cases of radiocarpal arthropathy requiring total wrist fusion.

The 2CMA technique with HCS achieved excellent pain relief, improved functionality, and high rates of bone consolidation. Compared with traditional four-corner arthrodesis, this approach avoids unnecessary joint fusion, preserving partial wrist mobility. The complications observed were minor and effectively managed.

2CMA using HCS is a reliable technique for treating advanced wrist arthritis, providing durable pain relief, functional improvement, and high fusion rates. Further studies comparing this approach with other arthrodesis techniques are warranted.