Purpose
Four-corner fusion (4CF) is a surgical option for refractory scapholunate advanced
collapse and scaphoid nonunion advanced collapse wrist arthritis. Preoperative range
of motion (ROM) predicts outcomes in many orthopedic procedures. This study investigates
ROM in a cohort of 4CF patients to examine the relationship between preoperative and
postoperative motion and identifies different clinical patterns.
Methods
We performed a retrospective review of 4CF patients. Patients with a history of inflammatory
arthritis and radiographic characteristics of inflammation were excluded. Demographics,
prior wrist surgery history, and ROM data were collected at preoperative and postoperative
intervals after cast removal at 8 weeks, 3 months, and 8 months. Regression analysis
compared the motion before and after 4CF. Subsequent cluster analysis to reduce confounding
compared postoperative motion differences in the top 20% to the bottom 20% of patients
by preoperative motion.
Results
We included 148 patients; 27 had prior surgery on the ipsilateral wrist. Preoperative
arc averaged 86° ± 28° (flexion 46° ± 17°, extension 40° ± 15°); 8-week arc 43° ±
19° (flexion 19° ± 12°, extension 24° ± 12°); 3-month arc 62° ± 17° (flexion 30° ±
12°, extension 32° ± 11°); and 8-month arc 74° ± 17° (flexion 36° ± 11°, extension
37° ± 12°). Preoperative and final arcs were (r = 0.39). Clustering by the preoperative
arc, the top 20% (mean 124° ± 15°) achieved a mean final arc of 81° ± 16°, while the
bottom 20% (mean 47° ± 16°) achieved a mean final arc of 65° ± 19°. Intercluster differences
were statistically significant. The bottom 20% gained motion postoperatively. Most
patients in the middle 60% did not differ significantly in postoperative motion.
Conclusions
Although wrist motion following 4CF correlates positively with preoperative motion,
most patients do not differ significantly in postoperative motion. Patients with substantial
preoperative motion deficits gain motion after 4CF. This information is important
when counseling patients, determining the timing of surgical intervention, and managing
expectations related to motion outcomes.
Type of study/level of evidence
Prognostic II.
Key words
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Article info
Publication history
Accepted:
June 13,
2022
Received:
August 6,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
