Functional outcomes of three-corner fusion without triquetrum excision versus conventional four-corner fusion in scaphoid non-union advanced collapse G II and III in active patients: a prospective randomized control trial

Abstract

Introduction: Four-corner fusion has long been the preferred treatment for stages II and III of scaphoid nonunion advanced collapse with intact radiolunate articulation. Three corner fusions were then proposed as a more limited procedure with improved ulnar deviation through triquetrum excision. However, we believe triquetrum preservation would decrease the radiolunate contact pressure without affecting the ulnar deviation range. Methods: This prospective randomized study was performed between March 2019 and May 2021 and involved a total of 34 patients who underwent four corner fusions or three corner fusions without triquetrum excision for SNAC grade II and III. The average follow-up period was 2 years. Follow-up included radiological and clinical evaluation (range of motion, grip strength, visual analogue scale, and modified Mayo wrist scores). Results: There were no significant differences between the two groups as regards the postoperative range of motion, grip strength, visual analogue scale, modified Mayo wrist scorers, and complication rate. However, the three-corner fusion group had less mean operative time compared to the four-corner fusion (mean ± SD; 77.6 ± 16.9, 103.8 ± 10.2 min – P < 0.001) respectively. Conclusion: The authors concluded that three-corner fusion without triquetrum excision offered a comparable functional outcome and complication rate to four-corner fusion with less operative time in the three-corner fusion group.

Keywords

• scaphoid fracture
• four-corner fusion
• snac wrist
• three corner fusion