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Partial Wrist Fusion (Four-Corner and Capitolunate Arthrodesis)

Limited intercarpal arthrodesis options — four-corner fusion (with scaphoid excision) and capitolunate (two-corner) fusion — for SLAC/SNAC wrist; preserves some midcarpal motion vs total wrist fusion.

Overview

Partial wrist fusion procedures, including four-corner arthrodesis and lunocapitate arthrodesis with scaphoid excision, serve as viable options for advanced carpal collapse and arthritis [4, 7]. These techniques provide reliable, resilient functional results that remain stable over time [7]. Lunocapitate arthrodesis with scaphoid excision yields functional and radiological results comparable to four-corner fusion while avoiding the deleterious effects on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. Radioscapholunate arthrodesis with compression screws and local autograft achieves a 100% union rate at a mean follow-up of 12 months in appropriately selected patients with a preserved midcarpal joint, with no complications reported at that interval [5].

Indications are dictated by specific joint pathology and degenerative status. Proximal row carpectomy is recommended if the lunate facet of the distal radius and head of the capitate are free of degenerative changes [9], whereas four-corner arthrodesis is reserved for wrists with advanced capitolunate arthritis [9]. Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy for scapholunate advanced collapse and scaphoid nonunion advanced collapse, demonstrating a high union rate with good clinical function and pain outcomes [10]. For midcarpal instability, treatment options include partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage, though current evidence relies on small case series with limited follow-up without comparative or randomized studies [8].

Alternative strategies include pyrocarbon capitate resurfacing implants, which may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis shows encouraging outcomes so far, though long-term survival is difficult to predict; conversion to midcarpal fusion remains a salvage option if necessary [14]. Modified AO arthrodesis combining proximal row carpectomy and rigid internal fixation is a highly predictable operation with much less morbidity and fewer complications than older techniques using distant bone graft [11]. At an average 3-year follow-up, capitolunate arthrodesis compares favorably to four-corner arthrodesis regarding range of motion, grip strength, DASH scores, and VAS [19].

Anatomy & Pathophysiology

Osseous Mechanics and Kinematics

The proximal carpal row drives motion, whereas the distal carpal row exhibits negligible intercarpal motion [32]. More than half of carpal motion during loaded extension occurs at the midcarpal joint [33]. Resection of up to 25% of the distal scaphoid does not significantly influence carpal kinematics but induces a mild lunate extension deformity [2]. Scaphoid nonunions dramatically impact carpal kinematics by partially uncoupling the proximal and distal carpal rows [31]. Accurate identification of carpal bone morphology is required to improve the understanding of carpal mechanics and pathology [39].

Ligamentous and Soft Tissue Dynamics

Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics [30]. Computed fiber elongations of dorsal carpal ligaments vary linearly with wrist position [26]. During simple unresisted wrist motions, force in the scapholunate interosseous ligament does not exceed 20 N [28]. Reconstruction of both volar and dorsal limbs of the scapholunate interosseous ligament aims to approximate the original anatomy, restore normal carpal mechanics, and prevent progression to scapholunate advanced collapse arthritis [42]. Static imaging techniques may accurately depict major wrist ligamentous injury, while dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction [34].

Kinematic Patterns and Functional Motion

Surgical groups with scapholunate advanced collapse demonstrate decreased wrist kinematic motion and functional performance compared with individuals with normal wrists [24]. Kinematic changes in scapholunate instability may predict the development of radioscaphoid arthritis and help identify a kinematically abnormal wrist [29]. A pattern of kinematic changes is established after scapholunate ligament injury despite individual variance [38]. Four-corner fusion motion is smoother and more closely replicates the normal axis and functional motion of the wrist compared to other methods [25]. A dart-throwing motion (DTM) at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion [27]. A wide range of dart-throwing motion (DTM) planes exists [40], and midcarpal arthrodesis adversely affects dart-throwing motion compared with radiocarpal arthrodesis [40]. During forearm rotation, the contact site of the scaphoid and the lunate on the distal radial articular surface changes minimally [41]. The simulated hammering task utilizes a coupled path of motion from extension and radial deviation to flexion and ulnar deviation [37].

Classification

Pyrocarbon Resurfacing: Pyrocarbon capitate resurfacing implants may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Pyrocarbon interposition arthroplasty is an alternative to total wrist arthrodesis when marked degenerative changes exist at the radiolunate joint, capitate head, or both [16].

Scaphoid Resection Kinematics: Resection of up to 25% of the distal scaphoid does not significantly influence carpal kinematics [2]. Resection of up to 25% of the distal scaphoid induces a mild lunate extension deformity [2]. Load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion [12].

Fusion Modalities: Lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion when properly executed [3]. Lunocapitate arthrodesis with scaphoid excision avoids the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. Scaphoid excision and four-corner arthrodesis for advanced carpal collapse has a low rate of conversion to total wrist arthrodesis [4]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time [7]. Functional results of four-corner fusion for SLAC and SNAC wrist are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [6]. Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening for advanced Kienböck disease [15].

Indications and Alternatives: Proximal row carpectomy is recommended if the lunate facet of the distal radius and head of the capitate are free of degenerative changes [9]. Four-corner arthrodesis is reserved for wrists with advanced capitolunate arthritis [9]. Proximal row carpectomy results in better outcomes and a lower complication rate compared to four-corner fusion in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists [18]. Results after total wrist joint arthroplasty vary probably as the result of different patient groups, implant types, and evolution of prosthetic designs [17].

Other Considerations: Treatment options for midcarpal instability include partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage [8]. There are no comparative series or randomized studies regarding treatment options for midcarpal instability [8]. The DREAD classification organizes and describes articular fragment escape patterns following distal radius fracture fixation [56].

Clinical Presentation

Chronic wrist disorders presenting with advanced carpal collapse or scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) warrant evaluation for partial wrist fusion. Diagnostic considerations include radioscapholunate arthrodesis, which achieves a 100% union rate at a mean follow-up of 12 months in patients with a preserved midcarpal joint [5]. This procedure also demonstrates no complications in appropriately selected patients [5]. For wrists with advanced capitolunate arthritis, four-corner arthrodesis is the reserved option, whereas proximal row carpectomy is recommended if the lunate facet of the distal radius and head of the capitate are free of degenerative changes [9].

Surgical alternatives and outcomes vary by pathology. Pyrocarbon capitate resurfacing implants may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Scaphoid excision and four-corner arthrodesis for advanced carpal collapse has a low rate of conversion to total wrist arthrodesis [4]. Functional results of four-corner fusion for SLAC and SNAC wrist are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [6]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time [7]. Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for SLAC and SNAC wrists [10].

Resection and fusion parameters significantly influence kinematics and outcomes. Resection of up to 25% of the distal scaphoid does not significantly influence carpal kinematics but induces a mild lunate extension deformity [2]. Load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion [12]. Lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion when properly executed [3]. However, including the triquetrum in the fusion site is associated with deleterious effects on ulnocarpal and proprioceptive dysfunction [3]. Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate, and minimal complications [13].

Instability and specific pathologies require distinct management strategies. Treatment options for midcarpal instability include partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage, though there are no comparative series or randomized studies for the treatment of midcarpal instability [8]. Excision arthroplasty for scapho-trapezial-trapezoid arthritis can provoke severe malalignment and midcarpal instability, potentially leading to an intercarpal arthrodesis with an outcome worse than STT fusion [48]. Delayed diagnosis and late reconstructive surgery for traumatic nondissociative carpal instability were associated with no improvement in radiolunate angle [23]. Better results were seen when arthrodesis was performed for avascular necrosis of the capitate [22].

Lunate and Kienböck disease management presents specific options. Lunate excision without midcarpal fusion resulted in a disease-free state with good painless range of motion at 6 years [20]. This approach avoids the recurrence associated with curettage and the motion loss associated with fusion [20]. In contrast, fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening for advanced Kienböck disease [15]. Modified AO arthrodesis of the wrist combining proximal row carpectomy and rigid internal fixation is a highly predictable operation with much less morbidity and fewer complications than older techniques using distant bone graft [11].

Investigations

Plain radiography: Standard imaging is critical for surgical planning and diagnosis. Measurements taken in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions [51]. Resection of up to 25% of the distal scaphoid does not significantly influence carpal kinematics but induces a mild lunate extension deformity [2]. Following scaphoid excision and four-corner fusion, load is preferentially transferred to the radiolunate joint [12]. Triquetral motion is limited after lunocapitate arthrodesis [52]. Maintaining anatomic lunate position leads to preservation of greater wrist motion and anatomic alignment in a patient undergoing 4-corner arthrodesis [53].

MRI: Proximal row carpectomy is recommended if the lunate facet of the distal radius and head of the capitate are free of degenerative changes [9]. Conversely, four-corner arthrodesis is reserved for wrists with advanced capitolunate arthritis [9]. Pyrocarbon interposition arthroplasty is an alternative to total wrist arthrodesis when marked degenerative changes exist at the radiolunate joint, capitate head, or both [16].

Other Considerations: Radioscapholunate arthrodesis with compression screws and local autograft achieves a 100% union rate at a mean follow-up of 12 months in appropriately selected patients with a preserved midcarpal joint and has no complications in this population [5]. Functional results of four-corner fusion for SLAC and SNAC wrist are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [6]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time [4, 7]. Lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion when properly executed and avoids the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. Scaphoid excision and four-corner arthrodesis for advanced carpal collapse has a low rate of conversion to total wrist arthrodesis [4]. Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate, and minimal complications [13]. Pyrocarbon capitate resurfacing implants may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening for advanced Kienböck disease [15]. Better results were seen when arthrodesis was performed for avascular necrosis of the capitate [22]. Lunate excision without midcarpal fusion resulted in a disease-free state with good painless range of motion at 6 years, avoiding the recurrence associated with curettage and the motion loss associated with fusion [20]. Treatment options for midcarpal instability including partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage have been described in small case series with limited follow-up, yet there are no comparative series or randomized studies for these treatments [8]. Delayed diagnosis and late reconstructive surgery for traumatic nondissociative carpal instability were associated with no improvement in radiolunate angle [23].

Treatment

Non-Operative

The provided evidence does not contain specific data regarding conservative management protocols; however, radiocarpal fusion is indicated for patients with isolated radiolunate or radioscapholunate arthritis who have failed non-surgical treatment [47].

Operative

Indications: Proximal row carpectomy is recommended when the lunate facet of the distal radius and the head of the capitate are free of degenerative changes, whereas four-corner arthrodesis is reserved for wrists with advanced capitolunate arthritis [9]. Pyrocarbon capitate resurfacing implants may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Pyrocarbon interposition arthroplasty serves as an alternative to total wrist arthrodesis when marked degenerative changes exist at the radiolunate joint, capitate head, or both, increasing operative options for challenging clinical scenarios [16]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time [7]. Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse [10].

Surgical Approach / Technique: Resection of up to 25% of the distal scaphoid did not significantly influence carpal kinematics and induced mild lunate extension deformity [2]. Lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. Modified AO arthrodesis of the wrist combining proximal row carpectomy and rigid internal fixation is a highly predictable operation with much less morbidity and fewer complications than older techniques using distant bone graft [11]. Arthroscopic partial capitate resection for Type Ia avascular necrosis provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up [55]. Arthroscopic interposition tendon arthroplasty for stage 2 scapholunate advanced collapse preserves motion, yields acceptable functional outcome, and reduces pain [49]. Treatment options for midcarpal instability including partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage have been described in small case series with limited follow-up, but there are no comparative series or randomized studies [8].

Implant Selection: Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate and minimal complications [13]. Nitinol staples offer reliable fixation for achieving union of the four-corner arthrodesis [45]. Radioscapholunate arthrodesis with compression screws and local autograft achieves a 100% union rate at mean follow-up of 12 months with no complications in appropriately selected patients with a preserved midcarpal joint [5]. Radial wrist hemiarthroplasty implants are not approved by the FDA for use in humans in the United States and must be performed as off-label use with full patient understanding and appropriate institutional review board approval [54].

Alignment / Balancing Strategy: Load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion [12].

Pain Management: Functional results of four-corner fusion for SLAC and SNAC wrist were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [6]. There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years [4]. Capitolunate arthrodesis compares favorably to four-corner arthrodesis at an average 3-year follow-up with respect to range of motion, grip strength, DASH scores, and VAS [19].

Other Considerations: Radiocarpal fusion aims to alleviate pain and improve range of motion in patients with isolated radiolunate or radioscapholunate arthritis who have failed non-surgical treatment [47].

Complications

Infection (PJI): The provided evidence does not contain specific data regarding infection rates, risk factors, or management for partial wrist fusion.

Aseptic loosening: Magnesium-based headless bone screws are contraindicated for partial wrist arthrodesis due to premature mechanical instability and implant failure [21]. Long-term survival of pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis is difficult to predict, though conversion to midcarpal fusion remains a salvage option [14].

Instability: Resection of up to 25% of the distal scaphoid induces a mild lunate extension deformity [2]. The reduction and association of the scaphoid and lunate procedure should be abandoned due to a majority of patients experiencing early radiographic failure in the short term [61]. Nonunion of the capitate was rare in a cohort of 53 patients, despite being previously described as the most common complication [64].

Stiffness / Arthrofibrosis: Functional results remain good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients undergoing four-corner fusion [6]. Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes [10].

Other Considerations: Pyrocarbon capitate resurfacing implants may represent a good alternative to total and partial wrist arthrodesis in chronic wrist disorders [1]. Lunocapitate arthrodesis with scaphoid excision avoids the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse [4]. Radioscapholunate arthrodesis with compression screws and local autograft achieved a 100% union rate with no complications at a mean follow-up of 12 months [5]. Treatment options for midcarpal instability, including partial wrist fusions, have been described in small case series with limited follow-up, but there are no comparative series or randomized studies [8]. Four-corner arthrodesis is reserved for wrists with advanced capitolunate arthritis, whereas proximal row carpectomy is recommended if the lunate facet of the distal radius and head of the capitate are free of degenerative changes [9]. Wrist arthrodesis combining proximal row carpectomy and rigid internal fixation has fewer complications than older techniques using distant bone graft [11]. Proximal row carpectomy results in better outcomes and a lower complication rate compared to four-corner fusion for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists [18]. Wrist fusion rates are higher in the four-corner fusion group compared to the proximal row carpectomy group [57]. Average costs are higher in the four-corner fusion group compared to the proximal row carpectomy group [57]. Conversion rates to total wrist arthrodesis are significantly higher with partial wrist arthrodesis (19.2%) than with proximal row carpectomy (4.9%) [58]. Partial wrist arthrodesis has a greater associated direct cost than proximal row carpectomy [58]. Arthroscopic resection of the proximal capitate with tendon interposition does not preclude the possibility of secondary arthrodesis in case of failure [59]. Some intercarpal arthrodeses yield good, predictable outcomes, while others are infrequently used due to unpredictable results and high complication rates [60]. Parallel K-wire placement across the midcarpal joints with scaphoid excision leads to a high rate of fusion with good patient outcomes long term [63].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within six months following scaphoid excision and four-corner arthrodesis for complex carpal dissociation, at which point satisfactory function is regained and the carpus remains stable on radiographs [43].

Full activity (months): While specific timelines for manual work or sport are not explicitly quantified in the provided evidence, patients with distal scaphoid fractures report normal self-assessed hand function, good wrist motion, and strength from an 8- to 11-year perspective [46]. Research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability [44].

Complete recovery / outcome plateau (months): Functional results for four-corner fusion in SLAC and SNAC wrists are good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients [6]. Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time [7]. There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years [4].

Rehabilitation protocol: Rehabilitation protocols must account for forearm rotation when managing scapholunate joint instability [44]. Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse [10]. Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate and minimal complications [13].

Functional milestones: Scaphoid excision and four-corner fusion provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site [3]. Patients after proximal row carpectomy reported better function during activities of daily living compared to those after four-corner fusion [50]. In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, proximal row carpectomy results in better outcomes and a lower complication rate compared to four-corner fusion [18].

Key Evidence

  • [L4] This surgical procedure may represent a good alternative to total and partial wrist arthrodesis. (10.1177/1753193413501730)
  • [L5] Resection of up to 25% of the distal scaphoid did not significantly influence carpal kinematics and induced mild lunate extension deformity. (10.1177/1558944720966717)
  • [L4] When properly executed, lunocapitate arthrodesis with scaphoid excision provides functional and radiological results comparable to four-corner fusion without the deleterious effect on ulnocarpal and proprioceptive dysfunction associated with including the triquetrum in the fusion site. (10.1177/1753193409105683)
  • [L4] There is a low rate of conversion to total wrist arthrodesis. (10.1016/j.jhsa.2010.01.025)
  • [L4] This technique is an effective method to perform radioscapholunate arthrodesis in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications. (10.1016/j.jhsa.2013.01.026)
  • [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. (10.1177/1558944716681949)
  • [L4] Scaphoid excision and four-corner fusion remains a viable option for patients with advanced wrist arthritis with reliable, resilient functional results that remain stable over time. (10.1016/j.jhsa.2014.06.118)
  • [L5] Treatment options including partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage have been described in small case series with limited follow-up, but there are no comparative series or randomized studies. (10.1177/1753193415617756)
  • [L4] The authors recommend PRC if the lunate facet of the distal radius and head of the capitate are free of degenerative changes, while reserving four-corner arthrodesis for wrists with advanced capitolunate arthritis. (10.1016/j.jhsa.2025.07.014)
  • [L4] Arthrodesis of the capitolunate and triquetrohamate joints offers a motion-preserving strategy with a high union rate and good clinical function and pain outcomes for the treatment for scapholunate advanced collapse and scaphoid nonunion advanced collapse. (10.1016/j.jhsa.2012.03.023)
  • [L4] This technique of wrist arthrodesis combining proximal row carpectomy and rigid internal fixation has proved to be a highly predictable operation with much less morbidity and fewer complications than with older techniques using distant bone graft. (10.1016/j.jhsa.2012.11.010)
  • [L5] Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion. (10.1007/s11552-007-9048-0)
  • [L4] Four-corner bone wrist arthrodesis by dorsal rectangular plating achieves an acceptable preservation of range of motion with good pain relief, an excellent consolidation rate and minimal complications. (10.1177/1753193409105684)
  • [L5] It is difficult to predict long-term survival, but the outcome so far is encouraging, and conversion to midcarpal fusion remains a salvage option. (10.1007/s11552-014-9698-7)
  • [L4] Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening. (10.1016/j.jhsg.2019.09.012)
  • [L4] Pyrocarbon interposition arthroplasty is an alternative to total wrist arthrodesis when marked degenerative changes exist at the radiolunate joint, capitate head or both, and increases operative options for challenging clinical scenarios. (10.1177/1753193417714400)
  • [L4] The results after total wrist joint arthroplasty vary probably as the result of different patient groups, implant types and evolution of prosthetic designs, and are not comparable with the present study. (10.1186/s12891-018-2172-x)
  • [L1] In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. (10.1016/j.jhsa.2024.01.011)
  • [L3] Capitolunate arthrodesis compares favorably to 4-corner arthrodesis at an average 3-year follow-up with respect to range of motion, grip strength, DASH scores, and VAS. (10.1016/j.jhsa.2009.05.018)
  • [L4] Lunate excision without midcarpal fusion resulted in a disease-free state with good painless range of motion at 6 years, avoiding the recurrence associated with curettage and the motion loss associated with fusion. (10.1177/1753193413488303)
  • [Case_report] Due to this disappointing result of the operation with premature mechanical instability, the authors cannot support the use of magnesium-based screws for partial wrist arthrodesis, at least not in dual use. (10.1155/2016/7049130)
  • [L4] Better results were seen when the arthrodesis fused. (10.1177/1753193414524876)
  • [L4] Delayed diagnosis and late reconstructive surgery were associated with no improvement in radiolunate angle. (10.1016/j.jhsa.2021.04.024)
  • [L2] Both surgical groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists. (10.1016/j.jhsa.2015.04.035)
  • [L3] Motion was smoother and more closely replicated the normal axis and functional motion of the wrist. (10.1016/j.jhsa.2015.02.027)
  • [L5] Despite complex carpal bone anatomy and kinematics, computed fiber elongations were found to vary linearly with wrist position. (10.1016/j.jhsa.2012.04.025)
  • [L5] Clinically, a DTM at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion. (10.1016/j.jhsa.2007.08.014)
  • [L5] However, during simple unresisted wrist motions, the force did not exceed 20 N. (10.1016/j.jhsa.2015.04.007)
  • [L3] These kinematic changes may predict the development of radioscaphoid arthritis and help identify a kinematically abnormal wrist. (10.1177/17531934241242676)
  • [L4] Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. (10.1016/j.jht.2023.09.011)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. (10.1016/j.jhsa.2008.03.008)
  • [L5] Advances in 3-dimensional and 4-dimensional imaging have provided clearer insight into carpal kinematics, establishing that the distal carpal row has negligible intercarpal motion while the proximal row drives motion. (10.1016/j.jhsa.2016.07.105)
  • [L4] More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint. (10.1016/j.jhsa.2012.10.035)
  • [L4] Static imaging techniques may accurately depict major wrist ligamentous injury, while dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction. (10.1177/1753193415610515)
  • [L4] The simulated hammering task was performed using a wrist motion that followed a coupled path of motion, from extension and radial deviation to flexion and ulnar deviation. (10.1016/j.jhsa.2010.04.021)
  • [L5] Despite individual variance, a pattern of kinematic changes was established after scapholunate ligament injury. (10.1177/1753193415600669)
  • [L5] Accurate identification of carpal bone morphology is required to improve our understanding of carpal mechanics and pathology. (10.1016/j.jhsa.2009.03.002)
  • [L5] This report updates information on wrist dart-throwing motion based on recent research regarding its kinematics, kinetics, and clinical applications, noting that a wide range of DT planes exists and that midcarpal arthrodesis adversely affects DT motion compared with radiocarpal arthrodesis. (10.1016/j.jhsa.2014.02.035)
  • [L5] During forearm rotation, the contact site of the scaphoid and the lunate on the distal radial articular surface changed minimally. (10.1016/j.jhsa.2013.01.021)
  • [L4] The technique aims to approximate the original anatomy and restore normal carpal mechanics to prevent progression to scapholunate advanced collapse arthritis. (10.1016/j.jhsa.2013.05.026)
  • [Case_report] The patient regained satisfactory function and returned to work at six months with stable carpus on radiographs. (10.1016/j.jhsa.2007.07.025)
  • [L5] This research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability and provides a valuable perspective in line with current rehabilitation principles. (10.1016/j.jht.2023.09.012)
  • [L4] In addition, they offer reliable fixation for achieving union of the four-corner arthrodesis. (10.1016/j.jhsg.2025.100805)
  • [L2] From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. (10.1016/j.jhsa.2017.06.016)
  • [L5] The procedure aims to alleviate pain and improve range of motion in patients with isolated radiolunate or radioscapholunate arthritis who have failed non-surgical treatment. (10.1016/j.jhsa.2022.04.002)
  • [L4] The procedure can provoke severe malalignment and midcarpal instability, leading to an intercarpal arthrodesis with an outcome potentially worse than STT fusion. (10.1177/1753193408098903)
  • [L4] This procedure preserves motion, yields acceptable functional outcome, and reduces pain. (10.1016/j.arthro.2018.10.134)
  • [L3] The patients after proximal row carpectomy reported better function during activities of daily living. (10.1177/1753193416638812)
  • [L5] Measurements in the middle of the scapholunate joint in neutral and 30° of ulnar deviation under fluoroscopic imaging best capture all stages of ligamentous disruptions. (10.1177/1558944717729219)
  • [L4] Triquetral motion is limited after lunocapitate arthrodesis. (10.1016/j.jhsg.2019.09.009)
  • [L5] Maintaining anatomic lunate position leads to preservation of greater wrist motion and anatomic alignment in a patient undergoing 4-corner arthrodesis. (10.1016/j.jhsa.2016.07.101)
  • [L5] Radial wrist hemiarthroplasty implants are not approved by the FDA for use in humans in the United States and must be performed as off-label use with full patient understanding and appropriate institutional review board approval. (10.1016/j.jhsa.2012.10.050)
  • [L4] It provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up. (10.1016/j.jhsa.2015.09.010)
  • [L5] The DREAD classification organizes and describes articular fragment escape patterns following distal radius fracture fixation to raise awareness and facilitate decision-making. (10.1016/j.jhsa.2024.07.018)
  • [L3] Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates. (10.1016/j.jhsa.2019.12.010)
  • [L3] Conversion rates to total wrist arthrodesis are significantly higher with PWA (19.2%) than with PRC (4.9%) and have a greater associated direct cost. (10.1016/j.jhsa.2017.07.032)
  • [L4] This approach does not preclude the possibility of secondary arthrodesis in case of failure. (10.1016/j.jhsa.2025.06.004)
  • [L5] While some procedures yield good, predictable outcomes, others are infrequently used due to unpredictable results and high complication rates. (10.1016/j.jhsa.2013.09.014)
  • [L4] With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores. (10.1016/j.jhsa.2014.07.014)
  • [L4] Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. (10.1177/15589447211057302)
  • [L4] Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort. (10.1016/j.jhsa.2016.07.099)

See Also

References

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[2] How Much Scaphoid Can be Safely Resected? A Biomechanical Analysis of the Effects of Distal Scaphoid Resection. HAND. 2020. DOI: 10.1177/1558944720966717

[3] Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409105683

[4] The Outcome of Scaphoid Excision and Four-Corner Arthrodesis for Advanced Carpal Collapse at a Minimum of Ten Years. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.01.025

[5] Radioscapholunate Arthrodesis With Compression Screws and Local Autograft. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.026

[6] Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist. HAND. 2016. DOI: 10.1177/1558944716681949

[7] Resilience of SLAC 4-Corner Fusion: Long-Term Follow-Up. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.118

[8] Midcarpal instability. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415617756

[9] Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four-corner arthrodesis. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.07.014

[10] Lunatocapitate and Triquetrohamate Arthrodeses for Degenerative Arthritis of the Wrist. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.03.023

[11] Modified AO Arthrodesis of the Wrist (With Proximal Row Carpectomy). The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.11.010

[12] Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study. HAND. 2007. DOI: 10.1007/s11552-007-9048-0

[13] Four-corner bone arthrodesis with dorsal rectangular plate: series and personal technique. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409105684

[14] Pyrocarbon Interposition Arthroplasty for Proximal Capitate Avascular Necrosis. HAND. 2014. DOI: 10.1007/s11552-014-9698-7

[15] Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2019.09.012

[16] Vascular anatomy of the capitate determined by micro-computed tomography angiography. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417714400

[17] Radiocarpal fusion and midcarpal resection interposition arthroplasty: long-term results in severely destroyed rheumatoid wrists. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2172-x

[18] Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.01.011

[19] Clinical Outcomes of Scaphoid and Triquetral Excision With Capitolunate Arthrodesis Versus Scaphoid Excision and Four-Corner Arthrodesis. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.05.018

[20] Three-dimensional analysis of the proximal articulating surfaces of the lunate and capitate. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413488303

[21] A Case of Implant Failure in Partial Wrist Fusion Applying Magnesium-Based Headless Bone Screws. Case Reports in Orthopedics. 2016. DOI: 10.1155/2016/7049130

[22] Avascular necrosis of the capitate: report of six cases and review of the literature. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414524876

[23] Traumatic Nondissociative Carpal Instability: A Case Series. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.04.024

[24] Surgical Treatments for Scapholunate Advanced Collapse Wrist: Kinematics and Functional Performance. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.04.035

[25] Comparison of the Clinical and Functional Outcomes Following 3- and 4-Corner Fusions. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.02.027

[26] Elongation of the Dorsal Carpal Ligaments: A Computational Study of In Vivo Carpal Kinematics. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.04.025

[27] 2007 IFSSH Committee Report of Wrist Biomechanics Committee: Biomechanics of the So-Called Dart-Throwing Motion of the Wrist. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.08.014

[28] Force in the Scapholunate Interosseous Ligament During Active Wrist Motion. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.04.007

[29] Radiocarpal and midcarpal kinematics in scapholunate instability: a four-dimensional CT study in vivo. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241242676

[30] Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.09.011

[31] Interfragmentary Motion in Patients With Scaphoid Nonunion. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.03.008

[32] Carpal Kinematics and Kinetics. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.105

[33] In Vivo Kinematics of the Scaphoid, Lunate, Capitate, and Third Metacarpal in Extreme Wrist Flexion and Extension. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.035

[34] Imaging in carpal instability. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415610515

[37] Carpal and Forearm Kinematics During a Simulated Hammering Task. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.04.021

[38] Impact of scapholunate dissociation on human wrist kinematics. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415600669

[39] Imaging Recognition of Morphological Variants at the Midcarpal Joint. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.03.002

[40] International Federation of Societies for Surgery of the Hand 2013 Committee's Report on Wrist Dart-Throwing Motion. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.035

[41] Changes in Contact Site of the Radiocarpal Joint and Lengths of the Carpal Ligaments in Forearm Rotation: An In Vivo Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.021

[42] Reconstruction of Both Volar and Dorsal Limbs of the Scapholunate Interosseous Ligament. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.026

[43] Complex Carpal Dissociation With Open, Complete, and Divergent Trapezium, Capitate, and Hamate Dislocation: A Case Report. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.07.025

[44] Influence of forearm rotation on the kinetic stabilizing efficiency of the muscles that control the scapholunate joint. Clinical application in proprioceptive and neuromuscular rehabilitation programs. Journal of Hand Therapy. 2024. DOI: 10.1016/j.jht.2023.09.012

[45] Midterm Outcomes of Four-Corner Fusion Surgery Using Nitinol Staples. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100805

[46] Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.016

[47] Radiocarpal Fusion: Indications, Technique, and Modifications. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.04.002

[48] Midcarpal instability after excision arthroplasty for scapho-trapezial-trapezoid (STT) arthritis. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408098903

[49] Arthroscopic Interposition Tendon Arthroplasty for Stage 2 Scapholunate Advanced Collapse. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.134

[50] Comparison of activities of daily living after proximal row carpectomy or wrist four-corner fusion. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416638812

[51] The Optimal Location to Measure Scapholunate Diastasis on Screening Radiographs. HAND. 2017. DOI: 10.1177/1558944717729219

[52] Triquetral Motion Is Limited In Vivo After Lunocapitate Arthrodesis. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2019.09.009

[53] The Effect of Capitate Position on Coronal Plane Wrist Motion After Simulated 4-Corner Arthrodesis. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.101

[54] “Off-Label” Use of Orthopedic Implants in the Wrist. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.050

[55] Arthroscopic Partial Capitate Resection for Type Ia Avascular Necrosis: A Short-Term Outcome Analysis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.09.010

[56] Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.07.018

[57] Proximal Row Carpectomy Versus 4-Corner Fusion: Incidence, Conversion to Fusion, and Cost. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.12.010

[58] A Comparative Analysis of Resource Utilization Between Proximal Row Carpectomy and Partial Wrist Fusion: A Population Study. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.07.032

[59] Arthroscopic Resection of the Proximal Capitate With Tendon Interposition for Isolated Capitolunate Osteoarthritis: A Retrospective Series of Six Cases. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.06.004

[60] Intercarpal Arthrodeses. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.09.014

[61] Reduction and Association of the Scaphoid and Lunate Procedure: Short-Term Clinical and Radiographic Outcomes. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.014

[63] Parallel K-Wire Placement Leads to Fusion and Midcarpal Settling in Scaphoid Excision Four-Corner Fusion. HAND. 2021. DOI: 10.1177/15589447211057302

[64] Capitate Fractures: A Review of 53 Patients. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.099

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