The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : RESEARCH PAPER

Authors
Nikita Golovachev
David Sylvester
Roya Khorram
Kassem Ghayyad
Abdo Bachoura
David C. Hirsch
Amir R. Kachooei
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
4-corner
Four corner fusion
Scaphoid excision
Screw
Staple
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 6
June 2026
Pages 387-393

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