Can Four Corner Fusion in Scaphoid Non-union Advanced Collapse (SNAC) Preserve Functional Range of Motion?

Faculty Medicine Year: 2025
Type of Publication: ZU Hosted Pages:
Authors:
Journal: zumj.journals.ekb.eg zumj.journals.ekb.eg Volume:
Keywords : , Four Corner Fusion , Scaphoid Non-union Advanced    
Abstract:
Abstract Background :A scaphoid fracture is one the most disabling fractures in the wrist joint due to its impact on a range of motion and hand grip when a fractured scaphoid is neglected or improperly treated leading to SNAC wrist deformity with 5 stages. In our study, we used the four-corner fusion method, scaphoid bone excision, and fixation using K. wires with partial wrist denervation to relieve pain and improve hand grip with preservation of functional range of motion. STUDY DESIGN: retrospective cohort study. OBJECTIVE: This study evaluated the clinical and radiological results of a simple technique of K wire fixation in the limited fusion of the wrist in four-corner fusion for the surgical management of scaphoid nonunion advanced collapse with partial wrist denervation. Materials and methods: In our study, 14 patients were included all of them were male they were heavy manual workers and farmers with an age range from 20-55 years all of them suffered from neglected fracture scaphoid at least 2 years before surgery and were treated conservatively except two patients. With 3 years followups between (2020-2023) all of them were managed by using four-corner fusion and K wires were used for fixation. we used MAYO, and VAS wrist scores for assessment in addition to radiological signs of fusion. Results: In fourteen cases from the frame of our study, 11 patients got good results, 2 patients got fair results and 1 patient got poor results. In all of our patients, the following items were reviewed in each patient: pain, range of motion [ROM], hand grip power, and degree of patient satisfaction. All of the patients had radiological signs of solid fusion at the end of the follow-up time with the mean duration of time to get complete fusion being [6-12] weeks with almost no complications during surgery. After surgery, one patient got a superficial infection in the wound that resolved with medical treatment. One patient suffered from dorsal impingement between radius bone and capitate. No one of our patients suffered from deep infection or nonunion. one patient suffered from a ruptured extensor tendon of the index finger; one patient needed revision to total wrist fusion after one year. Two patients suffered from transient ulnar-side wrist pain. Conclusion: In this study, there was a high rate of patient satisfaction, and the operation provided good results in pain relief. Long-term results have been encouraging due to rigid fixation with a fast, simple technique and less injury to articular cartilage, improvements in surgical exposes, fixation methods, and implants, promoting an early range of motion and quick union, and failure and complication rates have been reasonably low. Keywords: scaphoid, four-corner fusion, non-union, advanced carpus collapse
   
     
 
       

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