Our Summary

This research paper presents a new surgical technique for a specific type of wrist surgery called a four-corner arthrodesis. This surgery is often used to treat advanced wrist conditions such as scapholunate advanced collapse and scaphoid nonunion advanced collapse.

However, there are potential complications with the current methods, including the bone not healing properly, problems with the surgical hardware, and a condition called dorsal impingement which can cause pain and limit movement.

The authors suggest a new method, called a cerclage fusion technique, which offers a more secure internal fixation of the bone while providing effective compression. The technique avoids the back of the wrist and areas with cartilage.

The proposed benefits of this new method include easier placement of the fixation, a larger surface area for compression, avoiding areas with cartilage and the back of the wrist, and the ability to adjust the alignment in the mid-wrist joint. In simpler terms, the new method is expected to be easier to perform, cover a larger area, avoid problem areas, and provide more flexibility for adjustments.

FAQs

  1. What is four-corner arthrodesis and what conditions is it commonly performed for?
  2. What are some potential complications associated with current techniques of four-corner arthrodesis?
  3. What are the proposed benefits of the cerclage fusion technique for achieving four-corner arthrodesis?

Doctor’s Tip

A doctor may advise a patient undergoing joint fusion surgery to follow post-operative rehabilitation and physical therapy protocols diligently to promote proper healing and prevent stiffness or weakness in the affected joint. It is important for the patient to communicate any unusual pain or discomfort to their healthcare provider to address any potential complications promptly. Additionally, maintaining a healthy weight and participating in low-impact exercises can help support the fusion and prevent excessive stress on the joint.

Suitable For

Patients who are typically recommended for joint fusion procedures, such as four-corner arthrodesis, include those with symptomatic scapholunate advanced collapse, scaphoid nonunion advanced collapse, and wrist arthritis. These patients may have failed conservative treatments and are experiencing significant pain and functional limitations due to their condition. Joint fusion may be recommended to stabilize the joint, relieve pain, and improve overall function in these individuals.

Timeline

Before joint fusion:

  • Patient experiences chronic wrist pain, instability, and limited range of motion
  • Patient undergoes diagnostic tests such as X-rays, MRI, and physical examination to determine the extent of the joint damage
  • Orthopedic surgeon recommends four-corner arthrodesis as a treatment option
  • Patient undergoes pre-operative consultations and preparations for surgery

After joint fusion:

  • Patient undergoes four-corner arthrodesis surgery, where the four bones of the wrist are fused together using the cerclage fusion technique
  • Patient is placed in a splint or cast to immobilize the wrist and allow for proper healing
  • Patient undergoes physical therapy to regain strength and range of motion in the wrist
  • Patient follows up with the orthopedic surgeon for post-operative appointments to monitor healing and address any complications
  • Patient experiences improved stability, decreased pain, and increased function in the wrist over time as the fusion fully heals and integrates.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with joint fusion surgery?
  2. How long is the recovery period after joint fusion surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. What type of anesthesia will be used during the surgery?
  5. How long will the fusion last and will I need additional surgeries in the future?
  6. Are there any alternative treatments to joint fusion that I should consider?
  7. What kind of restrictions or limitations will I have after the surgery?
  8. How successful is joint fusion surgery for my specific condition?
  9. What is the expected outcome and prognosis after joint fusion surgery?
  10. How experienced are you in performing joint fusion surgeries and what is your success rate?

Reference

Authors: Goyal N, Bohl DD, Fernandez JJ. Journal: J Hand Surg Am. 2019 Aug;44(8):703.e1-703.e8. doi: 10.1016/j.jhsa.2019.02.016. Epub 2019 Mar 27. PMID: 30928022