Back to 2026 Abstracts
Ulnar Translocation in Patients undergoing Four-Corner Arthrodesis after a Previous Volar Approach
Lauren E Tagliero, MD
1, Aliya G Feroe, MD, MPH
1; Alexander Y Shin, MD
2(1)Mayo Clinic, Rochester, MN, (2)Orthopaedics, Mayo Clinic, Rochester, MN
OBJECTIVE: Palmar radiocarpal ligaments, particularly the radioscaphocapitate (RSC) ligament, are key stabilizers of the carpus. Disruption or attenuation of these ligaments may lead to ulnar translocation, a rare but difficult-to-treat condition. In some cases, repair of the volar ligaments is not feasible, theoretically increasing the risk of postoperative ulnar translocation and associated complications. This study evaluated the incidence of ulnar translocation following four-corner arthrodesis in patients with prior volar wrist surgery for scaphoid nonunion, compared to nonoperative controls. We hypothesized that previous volar surgery would result in increased postoperative ulnar translocation.
METHODS: A retrospective cohort study was performed at a single institution. Patients undergoing four-corner arthrodesis for scaphoid nonunion were identified and divided into two cohorts: (1) patients with prior volar wrist surgery and (2) patients with no prior wrist surgery. Charts were reviewed for demographic and operative data, including prior volar ligament repair. The primary outcome was lunate uncovering on final postoperative imaging, as described by Gilula. Secondary outcomes included change in ulnar translocation over time, postoperative ulnar-sided wrist pain, nonunion, and reoperation. Kaplan-Meier survival analysis was used to evaluate reoperation-free survival between cohorts.
RESULTS: Twenty patients were included (10 per cohort) with a mean radiographic follow-up of 24 months. There were no significant differences in baseline characteristics. No differences in ulnar translocation were found at any timepoint between groups (Table 1). Less preoperative translocation correlated with greater immediate postoperative change (p=0.001). Male sex was associated with increased translocation from immediate to late postoperative imaging (p=0.006). Prior volar approach was associated with less translocation when comparing preoperative to late postoperative imaging (p=0.043) (Table 2). Ulnar-sided wrist pain occurred in 3 control and 4 surgery cohort patients, with no associated risk factors. Two patients in each group developed nonunion requiring revision. Lesser late postoperative translocation was associated with reduced risk of nonunion (p=0.040). Four patients in each group underwent reoperation. No examined variables predicted reoperation. Kaplan-Meier analysis revealed no difference in reoperation-free survival (p=0.942) (Figure 1).
CONCLUSION:
Prior volar wrist surgery, regardless of volar ligament repair, did not increase the risk of ulnar translocation, ulnar-sided wrist pain, or reoperation following four-corner arthrodesis.
Back to 2026 Abstracts
