Francisco del Piñal, MD, PhD, PhD, Melissa Klausmeyer, MD, Carlos Thams, MD, Eduardo Moraleda, MD, Carlos Galindo, MD
Journal of Hand Surgery Vol 37A November, 2012 – 37A:2389-2399. Copyright © 2012 by the American Society for Surgery of the Hand.
ABSTRACT (full text pdf. below)
Early Experience With (Dry) Arthroscopic 4-Corner Arthrodesis: From a 4-Hour Operation to a Tourniquet Time
Purpose Scaphoidectomy and 4-corner arthrodesis (4CA) is an effective procedure for treating several degenerative conditions of the wrist. Recently, the arthroscopic approach to this operation was described. Although it is conceptually appealing, certain aspects make its application difficult. We present our technique for dry arthroscopic scaphoidectomy and 4CA, which reduces the operative time to less than 2 hours.
Methods Four consecutive patients underwent scaphoidectomy and 4CA. In each case, we performed the operation with a dry arthroscopic technique using cannulated screws for rigid fixation. We performed bone grafting from the distal radius in 2 patients and from the scaphoid itself in the other two. The relevant operative details are the use of a scapholunate portal, the resection of the scaphoid with a pituitary rongeur, and the placement of bone graft in a dry arthroscopic environment. Range of motion exercises are started 2 to 3 weeks after the operation.
Results The first operation took 4 hours. The last 2 were completed in 1 hour 45 minutes and 1 hour 55 minutes, respectively. No complications occurred. No operations were converted to an open procedure.
Conclusions Although the operation has a steep learning curve, it is conceptually appealing. It is too early to prove that the arthroscopic procedure has better results than the open 4CA; nevertheless, in our opinion it represents the future of wrist surgery.
Keywords: Wrist arthroscopy, wrist osteoarthritis, scaphoid nonunion, SNAC, SLAC