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Capitolunate Versus Four-Corner Fusion for Mid Carpal Arthrosis
Etka Kurucan, MD1, Alexis Kasper, BS2, Pedro K Beredjiklian, MD2 and Rick Tosti, MD3, (1)Temple University Hospital, Philadelphia, PA, (2)Rothman Orthopaedic Institute, Philadelphia, PA, (3)Orthopaedic Surgery and Sports Medicine, Rothman Institute, Philadelphia, PA

Midcarpal fusion is a procedure indicated for midcarpal arthrosis or instability, though the merits of fusing the triquetro-hamate joint in addition to the capitolunate joint are not known. The purpose of this study was to compare capitolunate fusion with four-corner fusion with a null hypothesis that no differences would exist in outcomes.
A retrospective chart review of patients with midcarpal arthrosis who underwent midcarpal fusion between the years 2013 and 2023 was conducted. Patients were separated into groups according to fusion type. Demographics and methods of fixation were recorded. Outcomes evaluated included success of fusion, range of motion, strength, complications, and revision surgery.
In total, 51 patients met inclusion criteria. Of these, 20 had capitolunate fusions and 31 had four-corner fusions. Complication rates were 2/20 (10%) and 9/31 (29%) in the capitolunate and four-corner fusion groups, respectively (p=0.17). Revision rates were the same as all these patients required a surgery for their complication. The two in the capitolunate group had hardware complications. In the four-corner group, two patients had a nonunion, four had hardware complications, one had persistent pain and stiffness, one developed carpal tunnel syndrome, and one had complex regional pain syndrome. There were no significant differences between the two groups with respect to range of motion, strength, DASH scores, and capitolunate angle measurements. There was a significant difference between the two groups with respect to pre- and post-operative ulnar translocation measurements (p<0.01).

There are no significant differences in outcomes between capitolunate fusion and four-corner fusion for the treatment of midcarpal arthrosis. As such, there may be no added benefit of fusing the triquetro-hamate joint.

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