Orthopedic Surgery Department, Mansoura University, Algomhoria Street, Mansoura, 33516, Dakahlia, Egypt.
BMC Musculoskelet Disord. 2024 Aug 20;25(1):653. doi: 10.1186/s12891-024-07755-w.
Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes.
This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported.
The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively.
The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF.
level IV evidence.
舟状骨骨不连伴进行性塌陷（SNAC）损伤常伴有不可逆转的退行性腕关节炎改变，需要手术干预。腕中关节融合仍然是治疗 SNAC II 和 III 型损伤的主要方法。四角融合（4CF）的成功依赖于稳定的舟月骨融合（LCF）。有报道仅依赖 LCF 进行管理。SNAC 损伤中 LC 和 4C 融合的结果并未广泛记录。本研究的目的是提供关于这两种融合术式在治疗 SNAC II 和 III 型腕关节损伤中的有效性的有价值的见解，重点报告相关并发症、功能和影像学结果。
本回顾性研究纳入了 2015 年至 2024 年间接受有限腕关节融合术的 65 例 SNAC II 和 III 型腕关节损伤患者，术后随访至少 2 年。排除标准包括腕关节不稳定、既往腕部手术干预和舟月骨进行性塌陷。根据融合术式，患者分为两组：LCF 组 31 例，4CF 组 34 例。从患者的病历中提取术前和术中数据。在最后一次随访时，对患者进行全面的影像学和临床评估。比较两组患者的临床结果，包括手握力、活动范围、上肢残疾问卷（DASH）评分、改良 Mayo 腕关节评分。报告任何相关并发症。
LCF 和 4CF 组的平均愈合时间分别为 74.7±15.6 和 72.2±13.2 天。在末次随访时，所有患者与术前相比功能均有改善，两组患者腕关节活动范围相似。LCF 组患者的功能腕关节评分略好（P>0.05）。LCF 组患者的平均握力明显更大（P=0.04），LCF 和 4CF 组的平均握力分别为健侧的 86.8%和 82.1%。
LCF 在治疗 SNAC II 和 III 型腕关节损伤方面并不逊于 4CF。通过更耗时的手术，LCF 可以高效地提供与 4CF 相当的结果。
IV 级证据。
