Four-Corner Fusion Surgery for SLAC and SNAC of the wrist: Screw Versus Staple Fixation

This study hypothesizes that, in patients undergoing four-corner fusion (4CF) surgery, the choice of fixation method-either headless compression screw (HCS) or staples (ST)-will not significantly impact postoperative complication rates, union rate, and functional outcomes.

A retrospective chart review was conducted on patients who underwent 4CF for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist at a single institution over thirteen years. Functional outcomes included postoperative complications, nonunion, subsequent surgery, wrist flexion-extension range of motion (ROM), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score, and the 12-Item Short Form Survey (SF-12).

Thirty-seven patients were identified with an average follow-up of 9.1 months (range: 3-24 months). Nineteen patients were treated with HCS, and 18 were treated with ST. There were no significant differences in the complication rates between the HCS and ST groups (P=0.73). In the HCS group, the main complications were pain (n=4), subsequent surgeries for revision or hardware removal (n=3), and nonunion (n=2). For the ST group, these were pain (n=5), subsequent surgeries for revision or hardware removal (n=5), and hardware loosening (n=4). Postoperatively, wrist flexion and extension ROM did not significantly change in either group. QuickDASH improved postoperatively in both groups (P<0.005). Only the ST group improved in the SF-12 physical component postoperatively (P=0.01).

In this small, retrospective case series with short follow-up, fixation choice between HCS and ST in 4CF for SLAC or SNAC did not significantly impact complication rates or functional recovery. Postoperative complications occurred at similar rates, with pain and the need for subsequent surgery being the most common.