A1 Refereed original research article in a scientific journal
The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis
Authors: Aleksi Vihanto, Tero Kotkansalo, Markus Pääkkönen
Publisher: THIEME MEDICAL PUBL INC
Publication year: 2019
Journal: Journal of Wrist Surgery
Journal name in source: JOURNAL OF WRIST SURGERY
Journal acronym: J WRIST SURG
Volume: 8
Issue: 3
First page : 202
Last page: 208
Number of pages: 7
ISSN: 2163-3916
DOI: https://doi.org/10.1055/s-0039-1678673
Abstract
Background Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically.
Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique.
Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse (n = 6), Preiser's disease (n = 1), radioscaphoid (n = 1), or capitolunar (n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws.
Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months.
Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement.
Background Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically.
Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique.
Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse (n = 6), Preiser's disease (n = 1), radioscaphoid (n = 1), or capitolunar (n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws.
Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months.
Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement.
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