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The Long Term Outcome of Four Corner Fusion
IA Trail, MD; Raj Murali, MD; John K. Stanley, MD; Michael Hayton, MD; Sumedh Talwalkar, MD; Ramankutty Sreekumar, MD; Ann Birch, MD
Wrightington Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom

Four-corner arthrodesis with excision of the scaphoid is an accepted salvage procedure for scapho-lunate advance collapse (SLAC) and scaphoid non-union advance collapse (SNAC) and has been undertaken in our unit for over 20 years. We have undertaken a retrospective review of 116 of these procedures performed in 110 patients between 1992 and 2009. Fifty-eight patients attended for a clinical evaluation and 29 responded by postal questionnaire. Although the surgical technique was standard, various methods of fixation were used including k wires, staples, bone screws, but predominantly the Spider plate.

Follow-up was a mean of 9 years and 4 months, (range 3 19 years). All patients reported a significant improvement in pain relief and approximately 50% of flexion extension. Although only 30% of radio-ulnar deviation. Grip strength was again approximately 50% on the contralateral side. Most patients reported a significant improvement in function with 87% returning to work.

In addition, radiological evaluation identified 28 patients (31%) who demonstrated ongoing signs of non-union, particularly around the triquetrum. Fourteen of these (15%) who undergone a further procedure, generally with success.

Finally none of the patients demonstrated any arthritic changes in the lunate fossa on follow-up x-ray and all secondary procedures were undertaken within 2 years of the primary.

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