Four-corner arthrodesis of capitate, lunate, triquetrum and hamate with H type titanium plate for the treatment of carpal collapse: clinical efficacy analysis

Objective To investigate the clinical efficacy of four-corner arthrodesis with H type titanium plate combined with scaphoid resection in the treatment of carpal collapse. Methods From May 2010 to June 2015, 12 patients with carpal collapse were treated by four-corner arthrodesis of capitate, lunate, triquetrum and hamate with H type titanium plate combined with scaphoid resection. The causes of carpal collapse included nonunion old scaphoid fracture in 6 cases, old trans-scaphoid perilunar dislocation in 5 cases and scapholunate advanced collapse in 1 case. The clinical efficacy evaluation included hand using condition, wrist movement, hand grip strength, the degree of wrist pain after resting or exerting force. Results The follow-up time ranged from 8 to 37 months with an average of 22 months. The postoperative hand grip strength averaged (33.5±6.5) kg (79% of the healthy side). The range of the wrist movement reached more than 50% of the healthy side. The wrist pain relieved obviously, and no complications such as bone nonunion and wound infection occurred. Conclusion The application of four-corner arthrodesis of capitate, lunate, triquetrum and hamate with H type titanium plate can save most of the wrist joint function with reliable fixation and high rate of fusion, which is an effective method for the treatment of carpal collapse. Key words: Wrist joint; Treatment outcome; Carpal collapse; H type titanium plate; Four-corner arthrodesis