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腕关节部分融合术（四角融合及头钩骨融合术）

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Patient-facing topic for four-corner and capitolunate (two-corner) fusion of the wrist — joint-preserving alternative to total wrist fusion that retains some bending motion.

Updated May 2026
一幅手绘插图，显示腕骨的部分融合。
部分腕关节融合术后的X线片：仅使用螺钉固定疼痛且患有关节炎的关节，保留健康关节的活动度，从而使腕关节保持一定的屈曲和旋转功能。 Cvpoucke / Wikimedia Commons, CC BY-SA 3.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

为何建议进行此手术

您的外科医生建议您进行部分腕关节融合术（也称为四角融合术或头钩骨融合术），以治疗腕部严重的磨损性关节炎。当非手术治疗未能提供足够的缓解，且您的特定关节损伤涉及头钩骨区域时，通常会提供此手术。该手术旨在通过将剩余的骨骼融合在一起，从而缓解疼痛并提供稳定性。

此手术的主要目标是为您提供可靠、持久的功能，并确保长期稳定。通过移除受损骨骼并连接其他骨骼，该手术旨在消除导致疼痛的摩擦，同时尽可能保留活动度。与全腕关节置换术或更广泛的融合术相比，这种方法提供了一种强有力的替代方案，有助于您在减少不适的情况下恢复日常活动。

手术前

您的外科医生可能会在手术前安排X光、血液检查或MRI，以检查您的手腕和整体健康状况。您需要在手术前禁食数小时，并停止服用某些药物，具体请遵循外科医生的指示。请安排朋友或家人开车送您回家，因为您不能自己开车。请携带一份当前所有药物的完整清单，并穿着舒适、宽松的衣服前往医院。该手术通过手腕背侧的单一切口进行。您的手术团队将直接与您在所有具体指示方面进行详细讨论。

手术当天

您将抵达医院，并与麻醉医师会面，讨论您的治疗方案。该手术将在全身麻醉下进行。在手术过程中，您将完全处于睡眠状态。部分患者可能还会接受区域神经阻滞以缓解术后疼痛；麻醉医师将根据您的具体情况在手术当天决定是否需要。

您的外科医生将通过手腕处的单个开放切口进行手术。随后，您将被移至复苏区，安全地苏醒。在麻醉效果逐渐消退期间，您将接受密切监测。

手术内容

您的外科医生将在手腕背侧做一个切口以到达关节。这种开放入路可直接进入内部骨骼。根据您的具体关节炎类型，外科医生可能会切除舟骨，或使用特殊植入物对头状骨进行表面置换。

接下来，外科医生将准备用于融合的关节面。如果您接受的是四角融合术，外科医生会切除舟骨，并将剩余的腕骨连接在一起。对于头状骨-月骨融合术，仅连接头状骨和月骨。外科医生会使用螺钉、 staples 或金属板将这些骨骼牢固固定，以促进愈合。可能会添加局部骨移植以帮助骨骼融合。

最后，外科医生用缝线闭合切口并敷上敷料。该手术的目标是在尽可能保留剩余关节活动度的同时，创建一个稳定且无痛的手腕。此手术适用于其他治疗无效的晚期关节炎手腕。

术后

您将在恢复室苏醒，您的医疗团队将为您管理疼痛。您的外科医生将在您的手腕处做一个单一的开放切口。您将带着厚厚的敷料和吊带或支具离开，以保护您的手腕。大多数患者在此手术后需要在医院过夜，但有些人可以在当天回家。您必须有人在最初的24小时内陪伴您，以帮助您。您将立即开始轻柔地活动手指。您的外科医生将指导您如何护理伤口以及何时重新开始使用您的手。

恢复

开放手术后，您的手腕和手部可能会出现疼痛和肿胀。这是身体愈合过程中的正常现象。您的外科医生将指导您如何通过药物和冰敷来管理这种不适。您将佩戴石膏或夹板，以保护正在融合的骨骼。

在术后初期，您需要抬高患肢以减轻肿胀。在室内活动时，您将使用吊带提供支撑。小心谨慎的情况下，可以进行吃饭或刷牙等简单日常活动。您的物理治疗师将教您轻柔的练习，以保持手指活动并防止僵硬。随着肿胀消退和活动度恢复，您将逐渐开始更多地使用手部。

您的外科医生和物理治疗师将指导您何时停止使用夹板以及如何增强握力。您的恢复时间可能与他人不同；您的外科医生和物理治疗师将根据您的愈合情况提供指导。随着疼痛减轻和手腕变得稳定，您将感到更加自信。

可能出现的问题

大多数患者恢复良好，但偶尔也会出现并发症。您的外科医生和医疗团队会密切监测您，以便尽早发现任何问题。

有时骨骼未能按预期愈合。您可能会感到剧烈疼痛，且普通止痛药无法缓解，或感觉手腕仍然不稳定。如果出现这种情况，请联系您的外科医生讨论后续步骤。

存在较小的可能性，关节日后可能需要完全融合。您可能会感到僵硬或疼痛逐渐加重，或在一段改善期后疼痛复发。您的外科医生将复查您的X光片，并在必要时与您讨论转为全腕关节融合术。

在某些情况下，骨移植材料或螺钉可能未能达到预期效果。您可能会感到手腕内有咔哒声或研磨感，或注意到突然出现的肿胀和压痛。请在下次复诊时提出此情况，以便您的外科医生检查内固定物。

如果您使用的是热解碳植入物，其长期效果可能难以预测。您可能会随着时间的推移出现疼痛或活动度丧失。如果植入物失效，融合手术仍是解决问题的可选方案。

本页面底部的并发症表格列出了典型的发生率，如需具体数据请查阅。

何时联系我们

如果您出现发热、伤口红肿加重或渗出，请立即联系我们。若出现突发剧烈疼痛或手部感觉丧失，请立即联系您的外科医生。如发现小腿肿胀或呼吸困难，请前往急诊就医。这些症状可能提示存在需要紧急处理的血栓或感染。

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • Resection of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion due to induced instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening [2].
  • The use of a pyrocarbon capitate resurfacing implant may represent a good alternative to total and partial wrist arthrodesis [3].
  • 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 [4].
  • There are no comparative series or randomized studies for the treatment of midcarpal instability [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 [5].
  • 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 [6].
  • 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 [7].
  • It is difficult to predict long-term survival of pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis, but the outcome so far is encouraging [9].
  • Conversion to midcarpal fusion remains a salvage option for pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis [9].
  • Radioscapholunate arthrodesis with compression screws and local autograft is an effective method to perform the procedure in appropriately selected patients with a preserved midcarpal joint [11].
  • Radioscapholunate arthrodesis with compression screws and local autograft achieves a 100% union rate at mean follow-up of 12 months with no complications [11].
  • Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions [13].
  • The use of magnesium-based headless bone screws for partial wrist arthrodesis is not supported due to premature mechanical instability [15].
  • Radial wrist hemiarthroplasty implants are not approved by the FDA for use in humans in the United States [23].
  • Radial wrist hemiarthroplasty implants must be performed as off-label use with full patient understanding and appropriate institutional review board approval [23].

Anatomy & Pathophysiology

  • Resection of over 25% of the scaphoid induces instability and unpredictable kinematics [1].
  • A dart-throwing motion (DTM) at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion [10].
  • Surgical groups for scapholunate advanced collapse demonstrate decreased wrist kinematic motion and functional performance compared with individuals with normal wrists [16].
  • Scaphoid nonunions partially uncouple the proximal and distal carpal rows [17].
  • Computed fiber elongations of the dorsal carpal ligaments vary linearly with wrist position [29].
  • During simple unresisted wrist motions, force in the scapholunate interosseous ligament does not exceed 20 N [30].
  • Kinematic changes in scapholunate instability may predict the development of radioscaphoid arthritis [31].
  • Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics [32].
  • The distal carpal row has negligible intercarpal motion while the proximal row drives motion [33].
  • More than half the motion of the carpus when the wrist was loaded in extension occurred at the midcarpal joint [34].
  • Static imaging techniques may accurately depict major wrist ligamentous injury, while dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction [35].
  • A pattern of kinematic changes was established after scapholunate ligament injury despite individual variance [38].
  • Accurate identification of carpal bone morphology is required to improve understanding of carpal mechanics and pathology [39].
  • A wide range of dart-throwing motion planes exists [40].
  • 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 changed minimally [41].
  • Reconstruction of both volar and dorsal limbs of the scapholunate interosseous ligament aims to approximate original anatomy and restore normal carpal mechanics [42].

Classification

  • Resection of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion due to induced instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening [2].
  • The use of a pyrocarbon capitate resurfacing implant may represent a good alternative to total and partial wrist arthrodesis [3].
  • 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 [4].
  • There are no comparative series or randomized studies for midcarpal instability treatment options including partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage [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 [5].
  • 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 [6].
  • Functional results were good at long-term follow-up for 4-corner fusion for SLAC and SNAC wrist despite radiographic changes in the radiolunate joint in 73% of patients [8].
  • Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows [17].
  • Simulated radiocarpal fusion and simulated partial carpal fusion decreased range of motion compared with the intact wrist [53].
  • The principal direction of wrist motion along the path of dart-thrower's motion was not significantly altered by simulated radiocarpal fusion or partial carpal fusion [53].
  • The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist [56].
  • Simulated radioscapholunate fusion confirmed the dart-thrower's hypothesis as wrist motion was primarily preserved from radial-extension toward ulnar-flexion [59].
  • Midcarpal stabilisation and scaphoid and triquetrum excision retains most wrist motion [60].

Clinical Presentation

  • Resection of over 25% of the scaphoid induces instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening [2].
  • Treatment options for midcarpal instability include partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage [4].
  • There are no comparative series or randomized studies regarding treatment options for midcarpal instability [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 [5].
  • There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse [6].
  • The reduction and association of the scaphoid and lunate procedure experiences early radiographic failure in the majority of patients in the short term [7].
  • Functional results for 4-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 [8].
  • It is difficult to predict long-term survival for pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis, though outcomes are currently encouraging [9].
  • Conversion to midcarpal fusion remains a salvage option for pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis [9].
  • A dart-throwing motion (DTM) at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion [10].
  • Lunate excision without midcarpal fusion resulted in a disease-free state with good painless range of motion at 6 years [12].
  • Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions [13].
  • Radiographic carpal collapse and ulnar translocation occurred in scaphocapitate arthrodesis for Kienböck disease, but patients were not symptomatic [19].
  • 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 [20].
  • Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term [21].
  • Ulnar-sided wrist pain is a common cause of upper extremity disability with a complex differential diagnosis [43].
  • Both trigger wrist and avascular necrosis of the capitate are rare disorders [49].
  • Excision arthroplasty for scapho-trapezial-trapezoid (STT) arthritis can provoke severe malalignment and midcarpal instability [50].
  • Midcarpal instability following excision arthroplasty for STT arthritis can lead to an intercarpal arthrodesis with an outcome potentially worse than STT fusion [50].

Investigations

  • Resection of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion due to induced instability and unpredictable kinematics [1].
  • 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 [4].
  • There are no comparative series or randomized studies regarding treatment options for midcarpal instability [4].
  • A dynamic CT scan of the wrist is a user-friendly way of measuring the scapholunate distance, which is minimal in the normal wrist below 40 years of age [57].
  • 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 [63].
  • Plain radiographs, CT, 3D-CT, and MRI are suboptimal modalities to assess capitate type [64].
  • A scaphoid fracture was by far the most common injury in patients with posttraumatic radial wrist tenderness, but it is not clear whether diagnosis of subtle injuries only demonstrated on MRI improves outcomes [62].
  • Delayed diagnosis and late reconstructive surgery for traumatic nondissociative carpal instability were associated with no improvement in radiolunate angle [58].
  • Delayed diagnosis of intercarpal injuries can result in persistent median nerve dysfunction [27].

Treatment

  • Resection of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion due to induced instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening [2].
  • The use of a pyrocarbon capitate resurfacing implant may represent a good alternative to total and partial wrist arthrodesis [3].
  • 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 [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 [5].
  • 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 [6].
  • 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 [7].
  • It is difficult to predict long-term survival of pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis, but the outcome so far is encouraging, and conversion to midcarpal fusion remains a salvage option [9].
  • Radioscapholunate arthrodesis with compression screws and local autograft is an effective method in appropriately selected patients with a preserved midcarpal joint, achieving a 100% union rate at mean follow-up of 12 months with no complications [11].
  • 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 [12].
  • Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions [13].
  • 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 [14].
  • The authors cannot support the use of magnesium-based screws for partial wrist arthrodesis due to premature mechanical instability [15].
  • Load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion [22].
  • 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 [23].
  • Arthroscopic resection of the proximal capitate with tendon interposition for isolated capitolunate osteoarthritis does not preclude the possibility of secondary arthrodesis in case of failure [24].
  • Better results were seen when arthrodesis fused in cases of avascular necrosis of the capitate [25].
  • The 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 [48].
  • 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 [51].
  • 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 [52].
  • Locking screws are important in improving the longevity of total wrist arthroplasty by imitating external or internal fixation for bridging large bony defects, allowing the carpal component to remain stable despite complete asymptomatic avascular bone necrosis around the capitate peg [55].
  • Arthroscopic interposition tendon arthroplasty for stage 2 scapholunate advanced collapse preserves motion, yields acceptable functional outcome, and reduces pain [61].
  • 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 [67].

Complications

  • Resection of over 25% of the scaphoid induces instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients receiving vascularized bone graft with capitate shortening and radial shortening [2].
  • Treatment options for midcarpal instability, including partial wrist fusions, tenodesis stabilizations, and arthroscopic capsular shrinkage, are described in small case series with limited follow-up without comparative series or randomized studies [4].
  • There is a low rate of conversion to total wrist arthrodesis following scaphoid excision and four-corner arthrodesis for advanced carpal collapse [6].
  • The reduction and association of the scaphoid and lunate procedure experiences early radiographic failure in the majority of patients in the short term [7].
  • Radiographic changes in the radiolunate joint occur in 73% of patients at long-term follow-up despite good functional results after 4-corner fusion for SLAC and SNAC wrist [8].
  • 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 [9].
  • Radioscapholunate arthrodesis with compression screws and local autograft achieves a 100% union rate at a mean follow-up of 12 months with no complications in appropriately selected patients [11].
  • Magnesium-based headless bone screws can result in premature mechanical instability and implant failure in partial wrist fusion [15].
  • Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good long-term patient outcomes [21].
  • Arthroscopic resection of the proximal capitate with tendon interposition does not preclude the possibility of secondary arthrodesis in case of failure [24].
  • While some intercarpal arthrodeses yield good, predictable outcomes, others are infrequently used due to unpredictable results and high complication rates [68].
  • Wrist fusion rates are higher in the 4-corner fusion group compared to proximal row carpectomy without a significant difference in readmission rates [70].
  • Conversion rates to total wrist arthrodesis are significantly higher with partial wrist arthrodesis (19.2%) than with proximal row carpectomy (4.9%) [71].
  • Partial wrist arthrodesis has a greater associated direct cost than proximal row carpectomy [71].
  • High complication rates following four-corner arthrodesis with a nonlocking plate have led to the recommendation for fixation with a locking screw plate [74].

Recovery

  • Resection of over 25% of the scaphoid induces instability and unpredictable kinematics [1].
  • Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening [2].
  • Pyrocarbon capitate resurfacing may represent a good alternative to total and partial wrist arthrodesis [3].
  • 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 [5].
  • 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 [6].
  • 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 [7].
  • Functional results were good at long-term follow-up for 4-corner fusion for SLAC and SNAC wrist despite radiographic changes in the radiolunate joint in 73% of patients [8].
  • It is difficult to predict long-term survival of pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis, but the outcome so far is encouraging [9].
  • Conversion to midcarpal fusion remains a salvage option for pyrocarbon interposition arthroplasty for proximal capitate avascular necrosis [9].
  • A dart-throwing motion at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion [10].
  • Both surgical groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists [16].
  • Further studies need to be performed to address differences in anatomy and wrist movement among patients with different lunate shapes regarding the dart-splint [18].
  • 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 [20].
  • Delayed diagnosis of intercarpal injuries can result in persistent median nerve dysfunction [27].
  • Research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability [44].
  • Radiocapitate range of motion after proximal row carpectomy was sufficient for activities of daily living [45].
  • A patient with complex carpal dissociation regained satisfactory function and returned to work at six months with stable carpus on radiographs [46].
  • Multicomponent exercise is important in the treatment of wrist instability [47].
  • 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 [66].

Key Evidence

  • [L5] Resection of over 25% of the scaphoid should be avoided or supplemented with partial wrist fusion due to induced instability and unpredictable kinematics. [1] (10.1177/1558944720966717)
  • [L4] Fusion of the proximal carpals developed in 3 of 7 patients who received vascularized bone graft with capitate shortening and radial shortening. [2] (10.1016/j.jhsg.2019.09.012)
  • [L4] This surgical procedure may represent a good alternative to total and partial wrist arthrodesis. [3] (10.1177/1753193413501730)
  • [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. [4] (10.1177/1753193415617756)
  • [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. [5] (10.1016/j.jhsa.2014.06.118)
  • [L4] There is a low rate of conversion to total wrist arthrodesis. [6] (10.1016/j.jhsa.2010.01.025)
  • [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. [7] (10.1016/j.jhsa.2014.07.014)
  • [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [8] (10.1177/1558944716681949)
  • [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. [9] (10.1007/s11552-014-9698-7)
  • [L5] Clinically, a DTM at approximately 30° to 45° from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion. [10] (10.1016/j.jhsa.2007.08.014)
  • [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. [11] (10.1016/j.jhsa.2013.01.026)
  • [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. [12] (10.1177/1753193413488303)
  • [L4] Scaphoidectomy and midcarpal fusion is a useful salvage procedure in a variety of degenerative conditions. [13] (10.1177/1753193410395357)
  • [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. [14] (10.1186/s12891-018-2172-x)
  • [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. [15] (10.1155/2016/7049130)
  • [L2] Both surgical groups demonstrated decreased wrist kinematic motion and functional performance compared with individuals with normal wrists. [16] (10.1016/j.jhsa.2015.04.035)
  • [L4] Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. [17] (10.1016/j.jhsa.2008.03.008)
  • [L5] Further studies need to be performed to address differences in anatomy and wrist movement among patients with different lunate shapes. [18] (10.1016/j.jht.2015.01.007)
  • [L4] Although radiographic carpal collapse and ulnar translocation occurred, patients were not symptomatic. [19] (10.1016/j.jhsa.2014.12.013)
  • [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. [20] (10.1016/j.jhsa.2017.06.016)
  • [L4] Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. [21] (10.1177/15589447211057302)
  • [L5] Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion. [22] (10.1007/s11552-007-9048-0)
  • [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. [23] (10.1016/j.jhsa.2012.10.050)
  • [L4] This approach does not preclude the possibility of secondary arthrodesis in case of failure. [24] (10.1016/j.jhsa.2025.06.004)
  • [L4] Better results were seen when the arthrodesis fused. [25] (10.1177/1753193414524876)
  • [Case_report] This case illustrates the importance of careful review of radiographs for evidence of intercarpal injuries, as delayed diagnosis resulted in persistent median nerve dysfunction. [27] (10.1007/s11552-013-9545-2)
  • [L5] Despite complex carpal bone anatomy and kinematics, computed fiber elongations were found to vary linearly with wrist position. [29] (10.1016/j.jhsa.2012.04.025)
  • [L5] However, during simple unresisted wrist motions, the force did not exceed 20 N. [30] (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. [31] (10.1177/17531934241242676)
  • [L4] Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. [32] (10.1016/j.jht.2023.09.011)
  • [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. [33] (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. [34] (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. [35] (10.1177/1753193415610515)
  • [L5] Despite individual variance, a pattern of kinematic changes was established after scapholunate ligament injury. [38] (10.1177/1753193415600669)
  • [L5] Accurate identification of carpal bone morphology is required to improve our understanding of carpal mechanics and pathology. [39] (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. [40] (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. [41] (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. [42] (10.1016/j.jhsa.2013.05.026)
  • [L5] Ulnar-sided wrist pain is a common cause of upper extremity disability with a complex differential diagnosis. [43] (10.1016/j.jhsa.2012.04.036)
  • [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. [44] (10.1016/j.jht.2023.09.012)
  • [L5] Radiocapitate range of motion after PRC was sufficient for activities of daily living. [45] (10.1016/j.jhsa.2006.10.014)
  • [Case_report] The patient regained satisfactory function and returned to work at six months with stable carpus on radiographs. [46] (10.1016/j.jhsa.2007.07.025)
  • [L4] These results highlight the importance of multicomponent exercise in the treatment of wrist instability. [47] (10.1016/j.jht.2023.08.010)
  • [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. [48] (10.1016/j.jhsa.2012.11.010)
  • [Case_report] Both trigger wrist and avascular necrosis of the capitate are rare disorders. [49] (10.1186/s12891-018-2010-1)
  • [L4] The procedure can provoke severe malalignment and midcarpal instability, leading to an intercarpal arthrodesis with an outcome potentially worse than STT fusion. [50] (10.1177/1753193408098903)
  • [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. [51] (10.1016/j.jhsa.2022.04.002)
  • [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. [52] (10.1177/1753193417714400)
  • [L5] Although both simulated fusion types decreased ROM compared with the intact wrist, the principal direction of wrist motion along the path of DTM was not significantly altered by simulated RCF or PCF. [53] (10.1016/j.jhsa.2017.10.017)
  • [L4] The case highlights the importance of locking screws in improving the longevity of total wrist arthroplasty by imitating external or internal fixation for bridging large bony defects, allowing the carpal component to remain stable despite complete asymptomatic avascular bone necrosis around the capitate peg. [55] (10.1016/j.jhsg.2024.01.002)
  • [L4] The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist. [56] (10.1016/j.jhsa.2022.04.015)
  • [L4] This novel dynamic CT scan of the wrist is a user-friendly way of measuring the scapholunate distance, which is minimal in the normal wrist below 40 years of age. [57] (10.1177/1558944717726372)
  • [L4] Delayed diagnosis and late reconstructive surgery were associated with no improvement in radiolunate angle. [58] (10.1016/j.jhsa.2021.04.024)
  • [L5] The fusion model confirmed the dart-thrower's hypothesis as wrist motion was primarily preserved from radial-extension toward ulnar-flexion. [59] (10.1016/j.jhsa.2007.12.013)
  • [L5] Results suggest that midcarpal stabilisation and scaphoid and triquetrum excision retains most wrist motion. [60] (10.1177/1753193408094923)
  • [L4] This procedure preserves motion, yields acceptable functional outcome, and reduces pain. [61] (10.1016/j.arthro.2018.10.134)
  • [L2] A scaphoid fracture was by far the most common injury, but it is not clear whether diagnosis of subtle injuries only demonstrated on MRI improves outcomes. [62] (10.1016/j.jhsa.2012.09.034)
  • [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. [63] (10.1177/1558944717729219)
  • [L4] Plain radiographs, CT, 3D-CT, and MRI are suboptimal modalities to assess capitate type. [64] (10.1007/s11552-015-9743-1)
  • [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. [66] (10.1177/1753193409105684)
  • [L4] It provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up. [67] (10.1016/j.jhsa.2015.09.010)
  • [L5] While some procedures yield good, predictable outcomes, others are infrequently used due to unpredictable results and high complication rates. [68] (10.1016/j.jhsa.2013.09.014)
  • [L3] Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates. [70] (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. [71] (10.1016/j.jhsa.2017.07.032)
  • [L4] Based on the high complication rate following FCA with a nonlocking plate, the authors no longer use this implant and recommend fixation with a locking screw plate. [74] (10.1016/j.jhsa.2017.10.036)

References

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b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.