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American Association for Hand Surgery

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Outcomes Following 2-corner, 3-corner, and 4-corner Arthrodesis for Midcarpal Arthritis: A Comparative Study
Justine Ring, MD, University of Manitoba, Winnipeg, MB, Canada, Tod Clark, MD, FRCSC, Department of Orthopedics, University of Manitoba, Pan Am Clinic, Winnipeg, MB, Canada and Jennifer L. Giuffre, MD, FRCS(C), Department of Surgery/Section of Plastic Surgery, University of Manitoba, Winnipeg, MB, Canada

Introduction: Four-corner fusion (4CF) is a common treatment for midcarpal arthritis, however alternatives including two and three-corner fusions (2CF, 3CF) have been described. Limited existing literature suggests 2CF and 3CF may improve range of motion, but have higher complication rates, specifically hardware migration after screw fixation. Our objective was to compare both functional and clinical outcomes between patients undergoing traditional 4CF, to 2CF/3CF when a staple fixation technique is used.

Materials & Methods: All adult patients undergoing 4CF, 3CF, and 2CF from 2011-2021 who attended at least one follow-up at our institution were included. 4CF patients were compared to those who underwent either 2CF or 3CF using staple fixation. Baseline demographics included age, smoking status, months of follow-up, and prior wrist surgeries. Outcomes included non-union, re-operation for any indication, progression to total wrist fusion, wrist range of motion, and grip strength.

Results: 58 patients met inclusion criteria. There were 49 4CF patients, and 9 2CF or 3CF patients. Baseline demographics were equal between groups. The rates of non-union, progression to total wrist fusion, and repeat surgery for any indication were not significantly different between groups. Range of motion (flexion-extension, radial-ulnar deviation) and grip strength at post-operative visits were not significantly different between groups (Table 1). However, significantly more 4CF patients required autologous bone grafting (p<0.001).

Conclusions: Although prior studies suggest increased risk of non-union and screw migration after 2CF/3CF, we did not observe higher complication rates as compared to 4CF at our institution. Range of motion, strength, and patient-reported outcomes were similar between groups. While 4CF is traditionally the procedure of choice for midcarpal fusion, we found that when using staple fixation, 2CF/3CF has comparable outcomes, and is associated with a decreased need for autologous bone grafting.

Table 1: Clinical and Functional Outcomes


2CF and 3CF



6 (12.2%)

1 (11.1%)


Progression to wrist fusion

3 (6.1%)

0 (0%)


Revision surgery (any)

7 (14.3%)

1 (11.1%)


Flexion-Extension arc (deg)

62.4 ± 26.0

62.6 ± 20.5


Radial-Ulnar deviation (deg)

29.8 ± 10.6

45.0 ± 21.2


Grip Strength (Kg)

25.3 ± 15.6

28.4 ± 6.0


Bone Grafting

42 (85.7%)

2 (22.2%)


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