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Scaphoid Excision and 4-Corner Fusion Using Retrograde Headless Compression Screws

Ball, Brandon MD*; Bergman, Joseph W. MD, FRCSC

Techniques in Hand & Upper Extremity Surgery: December 2012 - Volume 16 - Issue 4 - p 204–209
doi: 10.1097/BTH.0b013e3182688c6a

Scapholunate advanced collapse is a predictable form of wrist arthritis resulting from longstanding scapholunate instability. Four-corner fusion and scaphoid excision is a reliable procedure used to treat scapholunate advanced collapse wrist that improves pain and preserves range of motion. Multiple methods of achieving fixation have been described for the procedure including K-wires, staples, and headless compression screws. In previously described techniques, the compression screws are inserted in an antegrade manner, breaching the articular surface of the lunate. Even small areas of chondral damage may undermine the long-term durability of the radiocarpal joint. Given the 4-corner fusion relies on the integrity of the radiolunate articulation for success, it would seem advantageous to preserve the articular cartilage of the lunate. The technique described here involves retrograde insertion of headless compression screws to achieve a 4-corner fusion. Although it is still early, we anticipate that this procedure will result in similar fusion rates to other forms of fixation.

*Division of Plastic and Reconstructive Surgery

Division of Orthopedic Surgery, University of Alberta,Edmonton, AB, Canada

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Joseph W. Bergman, MD, FRCSC, 123, 11910-111 Avenue, Edmonton, AB, Canada T5G 0E5. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.