Four-Corner Fusion Surgery for SLAC and SNAC of the wrist: Screw Versus Staple Fixation

Document Type : RESEARCH PAPER

Authors

Rothman Orthopaedics Florida at AdventHealth, Orlando, Florida, USA

10.22038/abjs.2025.89889.4074

Abstract

Objectives: This study hypothesizes that, in patients undergoing four-corner fusion (4CF) surgery, the choice of fixation method—either headless compression screw (HCS) or staples (ST)—will not significantly impact postoperative complication rates, union rate, and functional outcomes.
Methods: A retrospective chart review was conducted on patients who underwent 4CF for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist at a single institution over thirteen years. Functional outcomes included postoperative complications, nonunion, subsequent surgery, wrist flexion-extension range of motion (ROM), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score, and the 12-Item Short Form Survey (SF-12).
Results: Thirty-seven patients were identified with an average follow-up of 9.1 months (range: 3-24 months). Nineteen patients were treated with HCS, and 18 were treated with ST. There were no significant differences in the complication rates between the HCS and ST groups (P=0.73). In the HCS group, the main complications were pain (n=4), subsequent surgeries for revision or hardware removal (n=3), and nonunion (n=2). For the ST group, these were pain (n=5), subsequent surgeries for revision or hardware removal (n=5), and hardware loosening (n=4). Postoperatively, wrist flexion and extension ROM did not significantly change in either group. QuickDASH improved postoperatively in both groups (P<0.005). Only the ST group improved in the SF-12 physical component postoperatively (P=0.01).
Conclusion: In this small, retrospective case series with short follow-up, fixation choice between HCS and ST in 4CF for SLAC or SNAC did not significantly impact complication rates or functional recovery. Postoperative complications occurred at similar rates, with pain and the need for subsequent surgery being the most common.
        Level of evidence: IV

Keywords

Main Subjects

References

  1. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984;9(3):358-65. doi:10.1016/s0363-5023(84)80223-3.
  2. Mavrogenis AF, Flevas DA, Raptis K, et al. Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients. Eur J Orthop Surg Traumatol. 2016;26(8):859-866. doi: 10.1007/s00590-016-1824-5.
  3. Erne HC, Broer PN, Weiss F, et al. Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations. J Plast Reconstr Aesthet Surg. 2019;72(6):909-917. doi:10.1016/j.bjps.2018.12.033.
  4. Le Corre A, Ardouin L, Loubersac T, Gaisne E, Bellemère P. Retrospective study of two fixation methods for 4-corner fusion: Shape-memory staple vs. dorsal circular plate. Chir Main. 2015;34(6):300-6. doi: 10.1016/j.main.2015.08.008.
  5. Pauchard N, Lecoanet-Strugarek C, Segret J, De Gasperi M, Dap F, Dautel G. Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study. Orthop Traumatol Surg Res. 2014;100(6):593-7. doi:10.1016/j.otsr.2014.05.016.
  6. De Smet L, Deprez P, Duerinckx J, Degreef I. Outcome of four-corner arthrodesis for advanced carpal collapse: circular plate versus traditional techniques. Acta Orthop Belg. 2009;75(3):323-7.
  7. Rodriguez-Merchan EC, Tabeayo-Alvarez ED, Shojaie B, Kachooei AR. Total Wrist Arthrodesis: An Update on Indications, Technique, and Outcomes. Arch Bone Jt Surg. 2023;11(3):144-153. doi:10.22038/abjs.2022.65875.3154.
  8. Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am. 2010;35(5):719-25. doi:10.1016/j.jhsa.2010.01.025.
  9. Mevel G, De Geyer A, Kim W, Ebalard M, Ropars M, Dreano T. Four-corner arthrodesis using the 4Fusion® quadripodal shape memory staple: a long-term review. J Hand Surg Eur Vol. 2022;47(4):387-392. doi:10.1177/17531934211063614.
  10. Mamede J, Castro Adeodato S, Aquino Leal R. Four-Corner Arthrodesis: Description of Surgical Technique Using Headless Retrograde Crossed Screws. Hand (N Y). 2018;13(2):156-163. doi:10.1177/1558944717702468.
  11. Iordache SD, Nam D, Paylan J, Axelord T. Four-corner arthrodesis using two headless compression screws. Acta Orthop Belg. 2016;82(2):332-338.
  12. Shintani K, Kazuki K, Takamatsu K, Yoneda M, Uemura T. Limited Wrist Arthrodesis for Scapholunate Advanced Collapse Wrist: Triangle Fixation for Four-Corner Fusion. J Hand Surg Asian Pac Vol. 2016;21(2):207-11. doi:10.1142/s242483551650020x.
  13. Hayes E, Cheng Y, Sauder D, Sims L. Four-Corner Arthrodesis With Differing Methods of Osteosynthesis: A Systematic Review. J Hand Surg Am. 2022;47(5):477.e1-477.e9. doi:10.1016/j.jhsa.2021.06.002.
  14. Andronic O, Labèr R, Kriechling P, et al. Surgical fixation techniques in four-corner fusion of the wrist: a systematic review of 1103 cases. J Plast Surg Hand Surg. 2023;57(1-6):29-37. doi:10.1080/2000656X.2022.2070182.
  15. Ledgard JP, Siddiqui J, Pelletier MH, Walsh WR, Scougall PJ. Midcarpal Arthrodesis Biomechanics: Memory Staples versus Cannulated Screws. J Hand Surg Asian Pac Vol. 2018;23(4):474-478. doi:10.1142/s2424835518500455.
  16. d'Almeida MA, Sturbois-Nachef N, Amouyel T, Chantelot C, Saab M. Four-corner fusion: Clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years' follow-up. Orthop Traumatol Surg Res. 2021;107(5):102886. doi:10.1016/j.otsr.2021.102886.
  17. Maia MV, de Moraes VY, Dos Santos JB, Faloppa F, Belloti JC. Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12. SICOT J. 2016:2:32. doi: 10.1051/sicotj/2016027.
  18. Gosling CM, Gabbe BJ, Williamson OD, Sutherland AM, Cameron PA. Validity of outcome measures used to assess one and six month outcomes in orthopaedic trauma patients. Injury. 2011;42(12):1443-8. doi:10.1016/j.injury.2011.05.022.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 6
June 2026
Pages 387-393

Files

History

  • Receive Date: 30 July 2025
  • Revise Date: 08 September 2025
  • Accept Date: 03 November 2025

Share

How to cite

Statistics