Four-corner Arthrodesis: Comparative Analysis of Open Surgery Versus Percutaneous Technique with Arthroscopic Assistance

Abstract

Introduction Four-corner arthrodesis is a salvage technique for patients with advanced carpal osteoarthritis. This procedure aims to reduce pain and preserve wrist motion. Even though percutaneous techniques with arthroscopic assistance reportedly have favorable outcomes and the advantages of minimal invasiveness, open surgery remains the gold standard for four-corner arthrodesis.

Objective The present study aims to compare the functional and radiological outcomes of patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) submitted to open surgery versus percutaneous surgery with arthroscopic assistance.

Materials and Methods Retrospective case-control study of clinical records and radiological images of patients with advanced carpal osteoarthritis submitted to percutaneous surgery with arthroscopic assistance versus open surgery. Demographic variables, pain score using the visual analog scale (VAS), function ranges of motion, time until consolidation, and correction of the capitolunate angle were analyzed. Both techniques are described.

Results In total, 22 male patients with an average age of 32.5 years were studied, including 13 patients from the case group (percutaneous surgery with arthroscopic assistance) and 9 patients from the control group (open surgery). The VAS score for pain at discharge was of 3 for the cases and of 5 for the controls (p = 0.008); 30 days postoperatively, it was of 0 and 3 respectively (p = 0.00). The ranges of extension and flexion were of 52.6° and 38.7° for the case group, and of 35.7° and 32.4° for the control group (p = 0.119 and 0.0016 respectively). The capitolunate angle was of 10° for the controls and of 5° for the cases (p = 0.0008). The time until consolidation was of 8.8 weeks for the cases and of 12.5 weeks for the controls (p = 0.039).

Discussion Both four-corner arthrodesis techniques are reproducible and effective in achieving consolidation, pain reduction and preservation of wrist motion.

Conclusion The present study demonstrates the superiority of the percutaneous technique with arthroscopic assistance over open surgery. Further prospective studies are required for an adequate recommendation.

Keywords

four-corner arthrodesis - SNAC - SLAC - wrist arthroscopy - wrist surgery

Publication History

Received: 05 May 2019

Accepted: 10 October 2020

Article published online:
02 June 2021

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