The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis.

Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically.  This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique.  We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse (  = 6), Preiser's disease (  = 1), radioscaphoid (  = 1), or capitolunar (  = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws.  Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months.  The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement.  This is a level IV, retrospective case series.