The Outcome of Scaphoid Excision and Four-Corner Arthrodesis for Advanced Carpal Collapse at a Minimum of Ten Years

Purpose Scaphoid excision and 4-corner arthrodesis is a salvage option for patients with advanced carpal collapse. This study aims to compare the clinical outcomes of 4-corner arthrodesis (FCA) at one year, 2 years, and a minimum of 10 years. Methods A cohort study was performed of patients having scaphoid excision and FCA procedure by a single surgeon. Thirty-one of 35 recruited were followed up for 10 years. The mean patient age was 47 years. All patients had scaphoid excision and FCA, using bone graft and 3M Shapiro staples (3M, St Paul, MN). Patients were followed up prospectively at one year, 2 years, and a minimum of 10 years after surgery by an independent observer. Three patients were lost to follow-up between the 2-year and 10-year assessments because they were untraceable, and one patient died at 7 years, without any further intervention. Before surgery, pain scores measured with a visual analog scale, range of wrist movement, grip and pinch strength, and scores from a self-assessment functional questionnaire were recorded prospectively. These measures were repeated at each time point, in addition to patient satisfaction scores measured on a visual analog scale. Results The pain scores decreased from a median preoperative score of 6/10 to 0/10 at one year. Grip strength did not change significantly. Wrist flexion decreased significantly after surgery, by an average of 22%. The average patient-reported satisfaction score was 8/10. There was no significant change in pain, wrist function, satisfaction, or arc of motion between one and 10 years. Two of 35 patients recruited had gone on to a total wrist arthrodesis for ongoing pain. Conclusions The outcome of scaphoid excision and 4-corner arthrodesis is favorable at one year and does not deteriorate significantly between one and 10 years. There is a low rate of conversion to total wrist arthrodesis. Pain scores are reduced at the cost of reduced wrist flexion. (J Hand Surg 2010;35A:719-725. Copyright (C) 2010 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic IV.