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Bahagyang Pagsasama ng Carpus

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Isang protektadong plano ng paggaling pagkatapos ng bahagyang pagsasama ng pulso (pagsasama ng capitolunate, kadalasang kasama ang pag-alis ng scaphoid) para sa isang pulso na nasira, na iinimmobilize hanggang sa mag-ugnay ang mga buto sa loob ng anim hanggang walong linggo, pagkatapos ay unti-unting ibabalik ang isang kapaki-pakinabang ngunit deliberdadong binabawasan na saklaw ng galaw ng pulso at lakas ng hawak.

Illustrasyon ng mga buto ng pulso na nagpapakita ng nasirang scaphoid na inalis at ang mga maliit na buto ng gitnang pulso (capitate at lunate) na pinagsama, habang ang kasukasuan sa pagitan ng lunate at ng buto ng forearms (radius) ay naiwan na malaya upang mapanatili ang ilang galaw.
Sa isang bahagyang pagsasama ng pulso, tinatanggal ang nasirang scaphoid at isinasama ang capitate sa lunate (isang capitolunate fusion); ang kasukasuan sa pagitan ng lunate at radius ay sinadyang pinapanatili, kaya’t nananatiling may kapaki-pakinabang, bagaman bawas, saklaw ng galaw ang pulso. Cvpoucke / Wikimedia Commons, CC BY-SA 3.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protokol na ito ay gabay sa iyong paggaling pagkatapos ng bahagyang pagsasama ng pulso (isang operasyon na nag-aalis ng scaphoid bone na nasira at nagpapa-fuse ng mga maliit na buto sa gitna ng pulso, kadalasan ang capitate sa lunate sa isang capitolunate fusion) kay Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, sinundan ng istrukturadong klinikal na protokol na isinulat para sa iyong hand therapist: dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong hand therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang partial wrist fusion ay ginagamot ang isang pulso na naging sira (arthritis) sa landas na sumusunod sa lumang problema sa scaphoid: maaaring ito ay scapholunate ligament injury (isang "SLAC" wrist) o lumang scaphoid fracture na hindi gumaling (isang "SNAC" wrist). Inaalis ang nasirang scaphoid, at pinagsasama ang mga buto ng gitnang pulso upang hindi na sila magkagaspang. Si Dr Hirpara ay kadalasang nagf-fuse ng capitate sa lunate (isang capitolunate fusion), minsan kasama ang mga kalapit na buto; kapag ang lunate, capitate, triquetrum, at hamate ay lahat ay pinagsama, ito ay tinatawag na four-corner fusion, at sumusunod ito sa mga parehong prinsipyo ng paggaling.

Ang pangunahing ideya sa likod ng operasyong ito ay bahagyang lamang ang pinagsasama ng pulso, hindi lahat nito. Ang kasukasuan sa pagitan ng lunate at ng buto ng forearms (ang radius) ay disenyadong hindi hawakan. Ang kasukasuang ito ang pinapanatili ang paggalaw ng pulso:

  • Ang pagf-fuse ng mga nasirang ibabaw ay nag-aalis ng sakit: ito ang pangunahing layunin, at matagumpay na nakukuha.
  • Ang pagpapanatili ng radius–lunate joint ay nagbibigay-daan upang mapanatili ang kapaki-pakinabang na paggalaw. Ang kapalit nito ay ang pagbabawas ng paggalaw: ang karamihan sa mga tao ay magkakaroon ng humigit-kumulang kalahati hanggang dalawang-katlo ng kanilang dating saklaw ng pagliko, at lakas ng hawak na humigit-kumulang tatlong-kapat ng kabilang panig. Ito ay isang normal, inaasahang resulta (hindi komplikasyon) at para sa isang masakit, nasirang pulso, karaniwang ito ay isang napakahalagang kapalit.

Ang mga pinagsamang buto ay nangangailangan ng oras upang mag-ugat nang matibay, katulad ng isang fracture. Sa loob ng mga unang anim hanggang walong linggo, ang pulso ay pinapanatiling tahimik sa isang cast o splint habang nangyayari ito. Sa panahong ito, ang mga daliri, hinlalaki, at forearm ay pinapanatiling malayang gumagalaw, ngunit ang pulso mismo ay pinahihintulutan na magpahinga. Kapag kumpirmahin ng doktor sa X-ray na ang mga buto ay nag-ugat, ang paggalaw ng pulso at pagkatapos ay pagpapalakas ay binubuksan sa maingat na yugto. Ang pagtatakda ng iyong mga inaasahan nang maaga (isang komportable, kapaki-pakinabang na pulso imbes na isang ganap na mobile) ay isang mahalagang bahagi ng paggaling.

Mga Paalala at Limitasyon

  • Panatilihing hindi gumagalaw ang iyong pulso habang nasa cast o splint hanggang sa kumpirmahin ng iyong doktor na gumaling na ang pagsasama ng mga buto (karaniwang anim hanggang walong linggo): kailangang mag-ugnay ang mga buto bago gumalaw ang pulso.
  • Panatilihing gumagalaw ang iyong mga daliri, hinlalaki, at forearms mula sa unang araw, ngunit huwag GALAWIN ang pulso mismo hangga’t hindi pa pinapayagan.
  • Huwag HUMAWAK nang mahigpit, mag-angat, itulak, hilahin, o magbigay ng bigat sa pamamagitan ng pulso hangga’t hindi pa kumpirmado ang tibay ng pagsasama: ito ay upang protektahan ang gumagaling na buto at anumang plate, turnilyo, o staples.
  • Inaasahan ang pagbabawas sa huling saklaw ng galaw: ito ang inaasahang resulta ng pagsasama ng bahagi ng pulso, hindi senyales na may nangyaring mali.
  • Panatilihing malinis at tuyo ang cast o dressing, at huwag MANEHOLA habang nasa cast o hindi kayang ligtas na kontrolin ang manibela.

Para sa pag-aalaga sa sugat, pamamahala ng pamamaga, at pag-aalaga sa peklat, tingnan ang gabay ng klinika tungkol sa pag-aalaga sa sugat.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong hand therapist, at manatili sa loob ng anumang range at limitasyon na ibinigay sa iyo. Ang mga maagang ehersisyo ay pinapanatiling gumagalaw ang mga daliri, hinlalaki, at forearms nang hindi nakakaapekto sa paggaling ng fusion; ang wrist mismo ay mananatiling tahimik sa loob ng cast o splint nito. Ang paggalaw ng wrist at pagpapalakas ng grip ay nasa mga huling yugto at hindi dapat simulan hanggang sa kumpirmahin ng iyong surgeon na nag-union na ang mga buto. Itigil ang anumang nagdudulot ng matulis na sakit sa wrist.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon pagkatapos ng bahagyang pagsasama ng pulso (capitolunate ± pag-aalis ng scaphoid; ang mga parehong prinsipyo ay nag-aaplay sa four-corner fusion). Ang seksyong ito ay dapat ibigay sa iyong hand therapist, at bawat yugto ay nagsisimula sa isang simpleng paliwanag sa wikang Ingles tungkol sa nangyayari. Hindi tulad ng pagkumpuni ng tendon, ang konstruksyon dito ay buto, at ang pag-unlad ay nakadepende sa radiographic union ng pagsasama, hindi sa isang nakapirming kalendaryo. Hangga’t hindi kumpirmado ng surgeon ang union, ang pulso ay naka-immobilize at ang mga daliri, hinlalaki, at forearms lamang ang gagalawin; pagkatapos nito, ibabalik ang range ng pulso at pagkatapos ay ang load, na may realistiko na hanggang humigit-kumulang 50–65% ng contralateral flexion–extension at ~70–80% ng grip.

Bago magsimula ng paggamot, suriin ang operation report ng pasyente at kumpirmahin ang fixation na ginamit (circular/dorsal plate, headless compression screws, staples o K-wires) at kung ang scaphoid ay na-excite. HINDI magsimula ng galaw ng pulso hangga’t hindi kumpirmado ng treating surgeon ang radiographic union (karaniwang 6–8 linggo, minsan ay mas matagal sa screw o staple fixation). Magbigay ng konsultasyon sa pasyente mula sa unang bisita na ang layunin ay isang walang sakit at functional na pulso na may disenyong bawas na arc, hindi buong mobility.

Yugto I — protektadong immobilisasyon hanggang sa pagkakaisa (linggo 0 hanggang ~6–8)

Ang pagkakaisa ay gumagaling tulad ng isang pagsira, kaya ang pulso ay pinapanatiling tahimik habang ang mga buto ay nag-uugnay. Ang kamay at forepaw ay pinapanatiling ganap na mobile upang maiwasan ang katigasan at pagdikit ng tendon, ngunit ang pulso ay hindi galawin.

Para sa iyong hand therapist:

Edukasyon at mga paalala - Ang pulso ay immobilised sa isang cast o splint hanggang sa kumpirmahin ng surgeon ang radiographic union (karaniwang 6–8 linggo) - Walang aktibo o pasibong galaw ng pulso sa yugtong ito - Walang pagkupot, pag-angat, pagtulak, paghila o pagdadala ng bigat sa pamamagitan ng operated na pulso - Itakda ang ekspektasyon nang maaga: ang huling galaw ay baba (nananatiling preserved ang radiolunate joint; ang midcarpal joint ay fused)

Pamamahala - Sugat: mga surgical dressing ayon sa utos; bulky dressing/splint sa loob ng ~10–14 araw, pagkatapos ay short-arm cast o thermoplastic splint; monitor para sa impeksyon - Oedema: elevation sa itaas ng antas ng puso, mahinahon na pagpump ng kamay, ice kung kinakailangan - Mga ehersisyo: ganap na aktibong finger, thumb at MCP/IP ROM; forearm pronation/supination; mahinahon na shoulder at elbow ROM; walang galaw ng pulso

Mga pamantayan upang mag-progres - Radiographic union na kumpirmado ng surgeon (huwag mag-progres sa kalendaryo lamang); healed na sugat; kontrolado ang pamamaga

Yugto II — pagpapanatili ng galaw ng pulso (mula sa pagkakaisa, ~linggo 6–8 hanggang 12)

Kapag kumpirmado ng doktor na matibay ang pagsama, alisin ang cast sa pulso at simulan ang banayad na paggalaw ng pulso. Unti-unti ang pag-unlad; paalalahanan ang pasyente na ang pinagsamang bahagi ay hindi na gumagalaw at mas maliit ang maabot na saklaw kaysa dati.

Para sa iyong hand therapist:

Pagsusuri - Aktibo at pasibong ROM ng pulso (pagliko/pagbentaha, radial/ulnar deviation), pag-ikot ng forearms, batayang grip, sakit at pamamaga, pagsusuri sa sugat/peklat

Edukasyon at mga paalala - Simulan ang aktibo at active-assisted na ROM ng pulso sa loob ng komportableng hangganan; lumipat sa isang naaalis na splint ng pulso para sa komportse/proteksyon sa pagitan ng mga sesyon - Patuloy na iwasan ang mabigat na paghawak, pagbuhat ng may bigat at pagtanggap ng bigat sa pamamagitan ng pulso hanggang sa magbigay ng pahintulot para sa pagpapalakas - Palakasin ang inaasahang reduced-motion (target ~50–65% ng contralateral na flexion–extension arc)

Pamamahala - Mga ehersisyo: aktibo/active-assisted na pagliko at pagbentaha ng pulso, radial at ulnar deviation; simulan ang scar massage at desensitisation kapag lubos nang gumaling ang sugat; patuloy na buong ROM ng daliri/palad at pag-ikot ng forearms; pamamahala ng oedema kung kinakailangan

Mga pamantayan para sa pag-unlad - Komportableng, kontroladong arc ng pulso sa loob ng inaasahang reduced range; pagbaba ng sakit; pahintulot ng doktor para sa pagpapalakas

Yugto III — pagpapalakas at pagbabalik sa gawain (mula ~12 linggo)

Kapag solid na ang pagsasama at naibalik ang galaw sa kanyang kapaki-pakinabang na hangganan, magsisimula ang pagpapalakas at unti-unting pagdadagdag ng karga, na binubuo sa loob ng mga linggo. Ang pagbabalik sa trabahong kamay at isport ay batay sa mga kriteryo.

Para sa iyong terapistang pang-kamay:

Pagsusuri - Lakas ng hawak at pinches kumpara sa kabilang bahagi; tugon sa sakit/pamamaga sa pagdadagdag ng karga; pagsusuri ng gawain at tiyak sa trabaho

Edukasyon at paalala - Magsimula sa unti-unting pagpapalakas ng hawak at pulso (putty, bola, pagkatapos ay unti-unting resistensya) kapag pinapayagan na - Ipakilala ang mga gawain na may karga at nagdadala ng bigat nang dahan-dahan; dagdagan sa loob ng ilang linggo imbes na sabay-sabay - Inaasahang katapusan: pagbawi ng hawak patungo sa ~70–80% ng kabilang bahagi at isang kapaki-pakinabang, walang sakit, na binabawasan na arkong galaw

Pamamahala - Mga ehersisyo: unti-unting paghawak at pagpapalakas ng forewrist/pulso; unti-unting pagsusuri ng gawain at simulasyon ng trabaho; patuloy na pamamahala ng peklat at pagpapanatili ng ROM - Mag-ingat at ibalik sa doktor kung may patuloy na sakit sa likod ng pulso sa pagpapalawak (posibleng dorsal impingement), inaasahang nonunion, o pagkabigay ng pagbawi - Isaalang-alang ang paglabas kapag sapat na ang lakas at gawain para sa pang-araw-araw at okupasyonal na pangangailangan ng pasyente

Mga Kriteryo para sa pagbabalik sa karga / trabaho - Solid na pagsasama, walang sakit sa loob ng naibalik na arkong galaw, sapat na hawak para sa gawain; mabigat na mga hinihinging trabaho ipinagbabawal hanggang ~4–6 buwan at unti-unting dinadagdag

Pagbabalik sa trabaho at gawain

Ang magaan na paggamit ng kamay sa pang-araw-araw (pagkain, pagsulat, magaan na pag-aalaga sa sarili) ay inirerekomenda mula sa simula, hangga't komportable, basta't hindi nagbibigay ng bigat o nag-iikot sa pulso. Dahil hindi maaaring magmaneho habang naka-cast ang pulso o hindi kayang kontrolin ang manibela nang ligtas, magplano ng tulong sa transportasyon sa mga unang linggo; maaari nang magmaneho kapag wala nang cast at kayang kontrolin ang sasakyan nang kumpiyansa, ayon sa pagpapatunay sa inyong follow-up.

Ang paghawak, pag-angat, at pagbibigat ng bigat sa pamamagitan ng pulso ay hinihintay hanggang sa kumpirmahin na matibay ang pagsasama (karaniwan pagkatapos ng anim hanggang walong linggo) at unti-unting pinapalakas. Ang mga taong naka-upo o gumagawa ng magaan na trabaho ay kadalasang bumabalik sa humigit-kumulang tatlong buwan; ang mas mabigat na pisikal na trabaho ay karaniwang nasa apat hanggang anim na buwan at ipinakilala nang yugto-yugto. Sa buong proseso, tandaan na ang layunin ay isang komportableng, kapaki-pakinabang na pulso na may bawas na saklaw ng galaw, na sinusukat sa pakiramdam at pagganap ng pulso, na pinamumunuan ni Dr. Hirpara at ng inyong hand therapist ang bilis, hindi lamang ang kalendaryo.

Pagkatapos ng iyong protokol

Ang protokol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika: tingnan ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat at pamamahala ng peklat. Ang naka-phase na plano sa itaas ay sumasalamin sa mga inilathala na gabay sa rehabilitasyon pagkatapos ng bahagyang pagsasama ng pulso, at ang iyong patuloy na paggaling ay indibidwal na pinamumunuan ni Dr. Hirpara at ng iyong hand therapist ayon sa kung paano gumagaling at umuunlad ang iyong pulso.

Reviewed by Dr Kieran Hirpara · 21 June 2026.

Want the clinical detail? Read the clinician version.

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Evidence & references

Partial Wrist Fusion — Procedure Outcomes & Post-operative Rehabilitation (Capitolunate / Four-Corner Arthrodesis with Scaphoid Excision)

Topic scope: post-operative rehabilitation after midcarpal partial wrist arthrodesis for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC). The index procedure here is a capitolunate fusion (the capitate fused to the lunate, usually with excision of the worn scaphoid); the closely related four-corner fusion (lunate–capitate– triquetrum–hamate) follows the same rehabilitation principles. This is a bony arthrodesis, so the rehabilitation is a union-gated pathway: the mid-wrist is immobilised until the fusion consolidates, after which a deliberately reduced wrist arc and grip are restored.

Defining principle of the rehab here: a partial wrist fusion is a motion-preserving salvage. The arthritic midcarpal surfaces are fused to abolish pain, while the radiolunate joint is intentionally preserved to retain movement. The construct that needs protecting is healing bone (plate, headless screws, staples or K-wires across the fusion), not a soft-tissue repair — so progression is gated by radiographic union, not a calendar. Counselling the patient that the planned end-point is a pain-free, functional wrist with a reduced arc (~50–65% of normal flexion–extension, ~70–80% grip) is itself part of the treatment: the reduced motion is the intended trade-off, not a failure. The two principal branch points are the fixation method (which sets the immobilisation window and union risk) and whether scaphoid excision was performed (standard in the SLAC/SNAC setting).

A. PROCEDURE OUTCOMES (capitolunate / four-corner fusion for SLAC–SNAC)

Partial wrist fusion is a well-established, durable salvage for the SLAC/SNAC wrist. The dominant debate is which motion-preserving salvage (four-corner / capitolunate fusion vs proximal row carpectomy), not whether to operate; both reliably relieve pain at the cost of some motion.

  • Reliable pain relief with a useful but reduced arc. Across series, midcarpal fusion abolishes the painful midcarpal arthritis while preserving radiolunate motion. Typical results are roughly 50–65% of contralateral flexion–extension and ~70–80% of contralateral grip strength, with high rates of pain relief and return to work — the expected, planned trade-off of a partial fusion [Enna Hand Clin 2005; Strauch J Hand Surg Am 2011; Merrell J Hand Surg Am 2008; long-term series J Wrist Surg 2015]. Moderate (cohort/consensus).
  • Capitolunate fusion (± scaphoid excision) performs comparably to full four-corner fusion while fusing fewer joints, simplifying the construct. A systematic review of capitolunate arthrodesis and comparative work report comparable motion, grip and union to four-corner fusion, supporting it as a sound index choice [Dunn J Hand Surg Am 2020 (systematic review); lunocapitate series J Hand Surg Eur 2009; J Chin Med Assoc 2017]. Moderate.
  • A meta-analysis of two-, three- and four-corner constructs finds the number of fused columns does not materially change motion, grip, union or complications — biomechanically consistent with the radiolunate joint being the motion-determining segment [Hundepool J Hand Surg Am 2025 (SR/meta-analysis); Hernandez-Soria J Hand Surg Am 2016 (capitate-position biomechanics)]. Moderate (SR) + mechanistic.
  • Modern fixation is forgiving but union is not guaranteed. Circular dorsal plates, headless compression screws and nitinol staples all achieve consolidation in the great majority, with nonunion and dorsal impingement the characteristic failures to watch for [Merrell J Hand Surg Am 2008 (circular plate); Ahmady J Hand Surg Glob Online 2025 (nitinol staples)]. Moderate.

B. REHABILITATION / THERAPY EVIDENCE

The rehab questions are (1) how long to immobilise, (2) what gates the start of wrist motion, and (3) how to set the patient's expectation of reduced motion. The evidence and published surgeon protocols converge on a union-gated sequence: immobilise the wrist (mobilise the hand and forearm) for ~6–8 weeks, then restore a reduced arc, then strengthen.

  • Immobilise until radiographic union, not by the calendar. Because the construct is bony, wrist motion is withheld until the surgeon confirms consolidation — typically 6–8 weeks, longer with some screw/staple fixations. Published institutional protocols use a bulky dressing/splint for ~10–14 days, a short-arm cast to ~4–6 weeks, then a removable splint as motion begins. Moderate (consensus protocols).
  • Keep the hand and forearm fully mobile from day one. Immediate active finger, thumb and forearm rotation prevents stiffness and tendon adhesion without disturbing the fusion — the same glide-preserving logic used across hand rehab. Consensus.
  • Restore motion gradually after union, against a realistic ceiling. Once united, active and active-assisted wrist ROM is introduced; patients should be counselled that the fused midcarpal segment will not move and the achievable arc is smaller than pre-operatively (the radiolunate joint alone supplies wrist motion). Consensus + mechanistic (capitate-position biomechanics, Hernandez-Soria 2016).
  • Strengthen and load only once the fusion is solid. Grip and loaded/weight-bearing work begins after union and is built up gradually; heavy manual demands are deferred to ~4–6 months. Consensus.

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Immobilisation (union) Week 0 to ~6–8 Wrist immobilised (cast/splint) Full active finger, thumb & forearm motion; oedema control, elevation; no wrist motion None through the wrist Fusion knits like a fracture; progress is gated by radiographic union, not the calendar
II — Restoring wrist motion From union (~wk 6–8) to 12 Heavy-load avoidance; removable splint Begin active/active-assisted wrist flexion/extension & deviation; scar massage once healed No loaded grip yet Counsel the reduced-arc expectation (~50–65% of normal flexion–extension)
III — Strengthening & return From ~12 weeks (post-union) Restrictions lifted progressively Progressive grip/wrist strengthening; graded job simulation Grip recovers toward ~70–80% of the other side Desk work ~3 months; heavy manual ~4–6 months. Watch for dorsal impingement / nonunion

(Phase windows mirror the precautions in the patient protocol and published surgeon protocols; they are typical guides anchored to union, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Capitolunate vs four-corner vs proximal row carpectomy (PRC). All three are accepted motion-preserving salvages for SLAC/SNAC. PRC tends to give a slightly larger arc and avoids fusion-specific complications (nonunion, dorsal impingement, hardware), while fusion may give marginally better grip and is preferred where capitate-head or proximal-capitate cartilage is compromised. Systematic reviews and a meta-analysis find no consistent superiority of one over the other; choice is individualised [Mulford J Hand Surg Eur 2009; J Hand Surg Am 2024 meta-analysis; Strauch J Hand Surg Am 2011]. Moderate (SR/meta-analysis of mostly observational data).
  2. Capitolunate vs full four-corner construct. Fusing fewer columns (capitolunate) simplifies the construct without clearly compromising motion, grip or union versus four-corner — consistent with the radiolunate joint being the motion-determining segment [Dunn 2020 SR; Hundepool 2025 meta-analysis; Hernandez-Soria 2016]. Moderate.
  3. When can wrist motion safely start? Union timing varies with fixation, and protocols differ on exact cast duration. The defensible position is surgeon-confirmed radiographic union gates wrist ROM rather than a fixed week number. Weak–moderate (consensus; protocol variation).
  4. Reduced motion is the plan, not a complication. The preserved radiolunate joint supplies a smaller arc by design; mislabelling the expected ~50–65% range as a poor result drives unnecessary dissatisfaction. Strong mechanistically; cohort-supported.
  5. Characteristic failures: nonunion and dorsal impingement. Both are recognised, fixation-related complications; persistent dorsal wrist pain on extension or a non-progressing fusion warrants surgical review rather than more therapy [Merrell 2008; Ahmady 2025; long-term series 2015]. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (mechanistic / well-supported): the reduced final arc is the planned consequence of preserving the radiolunate joint while fusing the midcarpal segment (capitate-position biomechanics); reliable pain relief from the fusion.
  • MODERATE: typical outcome envelope (~50–65% flexion–extension, ~70–80% grip); equivalence of capitolunate and four-corner constructs; no consistent superiority of fusion vs PRC (SR/meta-analysis of largely observational data); modern fixation achieves high union with defined nonunion / dorsal impingement risk.
  • WEAK / CONSENSUS: the specific union-gated immobilise → restore-motion → strengthen therapy sequence and exact phase timings (institutional/surgeon protocols, anchored to radiographic union rather than trial-derived).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Enna M, Hoepfner P, Weiss AC. Scaphoid excision with four-corner fusion. Hand Clin. 2005. DOI: 10.1016/j.hcl.2005.08.012
  • Dunn JC, Polmear MM, Scanaliato JP, et al. Capitolunate arthrodesis: a systematic review. J Hand Surg Am. 2020. DOI: 10.1016/j.jhsa.2019.10.007
  • Hundepool CA, Duraku LS, Quanjel TJ, et al. Two-, three-, or four-corner arthrodesis for midcarpal osteoarthritis: a systematic review and meta-analysis. J Hand Surg Am. 2025. DOI: 10.1016/j.jhsa.2023.04.018
  • Strauch RJ. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis — update on evaluation and treatment. J Hand Surg Am. 2011. DOI: 10.1016/j.jhsa.2011.01.018
  • Merrell GA, McDermott EM, Weiss AC. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am. 2008. DOI: 10.1016/j.jhsa.2008.02.001
  • Hernandez-Soria A, Das De S, Model Z, et al. The effect of capitate position on coronal plane wrist motion after simulated 4-corner arthrodesis. J Hand Surg Am. 2016. DOI: 10.1016/j.jhsa.2016.07.101
  • Ahmady AA, Zalzaleh M, Riedel BB. Midterm outcomes of four-corner fusion surgery using nitinol staples. J Hand Surg Glob Online. 2025. DOI: 10.1016/j.jhsg.2025.100805
  • Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrists: a systematic review of outcomes. J Hand Surg Eur Vol. 2009. DOI: 10.1177/1753193408100954
  • Four-corner fusion versus proximal row carpectomy for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist: a systematic review and meta-analysis. J Hand Surg Am. 2024. DOI: 10.1016/j.jhsa.2024.01.011
  • Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists. J Hand Surg Eur Vol. 2009. DOI: 10.1177/1753193409105683
  • Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist. J Chin Med Assoc. 2017. DOI: 10.1016/j.jcma.2016.10.001
  • The long-term outcome of four-corner fusion. J Wrist Surg. 2015. DOI: 10.1055/s-0035-1549277

Partial wrist fusion rehabilitation literature (protocols & guidance — basis for the union-gated phase structure)

  • University of Virginia Department of Orthopaedic Surgery. Wrist Partial Fusion (4-Corner) Rehabilitation Guidelines. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2024/09/Wrist-Partial-Fusion-4-corner.pdf
  • Oregon Health & Science University (OHSU). Four-Corner Partial Wrist Fusion — Surgery Guide. https://www.ohsu.edu/sites/default/files/2020-12/Four-Corner%20Partial%20Wrist%20Fusion.pdf
  • Alaska Orthopedic Specialists. Four-Corner Fusion with Scaphoid Excision — Post-operative Protocol. https://www.akortho.com/wp-content/uploads/Four-Corner-Fusion-with-Scaphoid-Excision-1.pdf
  • Twin Cities Orthopedics (Olson). Scaphoid Excision 4-Corner Fusion Post-operative Protocol. https://www.toportho.com/wp-content/uploads/2024/10/olson-_4-Corner-Fusion-Protocol.pdf
  • The long-term outcome of four-corner fusion (open-access full text). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4408128/

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