The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis

Abstract

Background Midcarpal “four-corner” wrist arthrodesis may be done from an open arthrotomy or arthroscopically. Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique. Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse (n = 6), Preiser's disease (n = 1), radioscaphoid (n = 1), or capitolunar (n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws. Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months. Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement. Level of Evidence This is a level IV, retrospective case series.

Lateral approach for scaphoid excision and capitolunate arthrodesis in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists

“…With regard to minimally invasive or arthroscopic procedures, there is a learning curve that sometimes hinders surgeons from learning or performing. [10,19] In our series, the longest recorded operating time using this method was during the rst case, which took 2 h 25 min, whereas the shortest recorded time among the later cases was 55 min. No obvious learning curve is needed, and the operative time does not need to be prolonged.…”

“…Therefore, the advantages of arthroscopic treatment can be mimicked. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Their results showed that the average extension/ exion arc was 68.6° (0°-96°) and the QuickDASH scores averaged 7.8 (range, 0-32.5).…”

Uso do portal piramidal-hamato na fusão de punho de quatro cantos: Um bom truque técnico*

“…Afterwards, the surgical steps are similar to those of the standard approach for a four-corner fusion. 3 4…”

Handgelenkarthroskopie

“…Mit dieser ist es auch möglich, innerhalb relativ kurzer Zeit ganze Knochen, wie zum Beispiel ein sklerotisches Skaphoid, zu resezieren (▶ Abb. 5) [8]. Auch eine Resektion des Processus styloideus radii ist arthroskopisch gut und komplikationsfrei unter Beachtung der korrekten Operationstechniken möglich [9].…”

“…Eine sehr interessante und für den Patienten vorteilhafte Entwicklung stellen die arthroskopisch assistierten Arthrodesen und Teilarthrodesen am Handgelenk dar [7]. Auch die Resektion ganzer Knochen, wie beispielsweise eines nekrotischen Skaphoids, sowie des Processus styloideus radii ist arthroskopisch, auch in Kombination mit perkutanen Arthrodesen, möglich [8,9]. Im Folgenden sollen die einzelnen Verfahren beschrieben werden.…”