Two-Column Intercarpal Arthrodesis Using Headless Compression Screws

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Arthritis Treatment

Background:

• Advanced wrist arthritis, including scapholunate advanced collapse and scaphoid nonunion advanced collapse grade III, significantly impacts patient function and quality of life.
• Two-column midcarpal arthrodesis (2CMA) after scaphoidectomy is an established treatment, but outcomes with headless compression screws (HCS) require long-term evaluation.

Purpose of the Study:

• To evaluate the clinical and radiographic outcomes of 2CMA utilizing HCS over a 21-year period.
• To assess the efficacy of 2CMA with HCS in managing advanced wrist arthritis, focusing on pain, function, and fusion rates.

Main Methods:

• A retrospective study of 128 patients undergoing 2CMA with HCS between 2001 and 2022.
• Preoperative arthroscopy confirmed radiolunate joint integrity. Clinical outcomes assessed via MMWS, DASH, and PRWE. Radiographic analysis evaluated bone fusion. Statistical analysis compared pre- and postoperative data.

Main Results:

• Significant improvements observed in pain (VAS), and functional scores (MMWS, DASH, PRWE) (p < 0.001).
• Wrist range of motion and grip strength increased significantly (p < 0.001 and p < 0.05, respectively).
• 99% radiographic bone fusion achieved with a 4% complication rate, including two cases requiring total wrist fusion.

Conclusions:

• 2CMA with HCS is a reliable and effective technique for advanced wrist arthritis, yielding durable pain relief and functional improvement.
• The procedure demonstrates high fusion rates and preserves partial wrist mobility, offering an advantage over broader fusion techniques.
• Further comparative studies investigating 2CMA with HCS against alternative arthrodesis methods are recommended.