Outcomes of Three Corner Fusion without Triquetrum Excision versus Conventional Four Corner Fusion in SNAC Wrist.

Background: Four corner fusion (4CF) has long been the preferred treatment for stages II and III of scaphoid nonunion advanced collapse (SNAC) with intact radiolunate articulation. Three corner fusion (3CF) with excision of the triquetrum was then suggested aiming to improve wrist motion. Several concerns had been emerged regarding proprioceptive function of the triquetrum and risk of early progression to radiolunate arthritis following excision. Three corner fusion without triquetrum excision (3CFT) was suggested as a relevant alternative to conventional limited fusion techniques. Since then, there is an on-going debate on the best technique to use for SNAC wrist. The authors evaluated the functional and operative outcomes of 4CF versus 3CFT in SNAC wrist. Materials and Methods: A total of 34 patients underwent four corner fusion or three corner fusion without triquetrum excision for SNAC grade II and III. The average follow-up period was 1 year. Clinical evaluations were conducted and determined by radiographs, range of motion, grip strength, visual analog scale, and modified Mayo wrist scores. Results: There were no significant differences between the demographic data, preoperative and postoperative parameters between the two groups. There was a significant difference in the operative time between the two groups (P<0.001). There was no significant difference between the two groups regarding the complication rate. Conclusions: The authors concluded that 3CFT offered a comparable functional outcome to 4CF with less operative time with no significant complications or mortality. [ABSTRACT FROM AUTHOR]