Scaphoid excision with four-corner fusion.

The scaphoid is an important anatomic and biomechanical link between the proximal and distal carpal rows [1]. This is elucidated by two scaphoid injury modelsdscaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC). In the past, end-stage SLAC/SNAC arthritis generally was treated with a total wrist arthrodesis [2]. Since the 1980s, scaphoid excision and four-corner fusion has become an increasingly popular treatment option for patients who have stage II or III SLAC/ SNAC arthritis. This article (1) provides a brief overview of carpal kinematics, (2) describes the stages of SNAC and SLAC arthritis, (3) offers treatment options for SNAC/SLAC wrists, (4) reviews the surgical techniques for four-corner fusion, and (5) presents the current data supporting the use of four-corner fusion for SLAC/SNAC arthritis.