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
