Four corner fusion for the management of scaphoid nonunion advanced collapse – A new technique | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 50, Issue 1, January 2015, Page 20-24 PDF (590.82 K) | ||||
| DOI: 10.4103/1110-1148.163116 | ||||
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| Author | ||||
| Mostafa Mahmoud | ||||
| Abstract | ||||
| Background There are several techniques to achieve four corner fusion to provide pain relief in cases of scaphoid nonunion advanced collapse (SNAC) wrist while preserving a function, but can be complicated with malunion, nonunion, hardware impingement or incomplete correction of the lunate extension. We evaluate a new time preserving and simple technique to achieve four corner fusion for the management of nonunion scaphoid with painful arthritis of the wrist. Patients and methods A prospective study was conducted on 16 patients with SNAC of the wrist. Their mean age was 31 years, and the average duration of symptoms was 21 months (range 5–60 months). Through a dorsal approach using a tubular osteotome, the junction between the capitate, lunate, hamate and triquetrium was excised down to the volar capsule and replaced with a core of cancellous iliac bone graft extracted using the same tool. Results The preoperative mean range of wrist flexion was 53° (30°–80°), the mean range of wrist extension was 56° (30°–80°), the mean visual analogue score was 3.2 and the Mayo score was poor in five, fair in three and good in six patients. The postoperative mean range of wrist flexion was 44° (10°–60°), the mean range of wrist extension was 49° (20°–70°), the visual analogue score was 0.7 and the Mayo score was excellent in eight patients, good in seven and poor in one patient. Only one patient proceeded to nonunion. Conclusion This new simple technique can be performed to achieve four corner fusion in the management of SNAC. | ||||
| Keywords | ||||
| fusion; nonunion; Scaphoid | ||||
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