Jnl Wrist Surg 2017; 06(04): 294-300
DOI: 10.1055/s-0037-1602587
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis

Avanthi Mandaleson1, Michael Wagels2, 3, Stephen K. Tham1, 2, 3
  • 1Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong, Victoria, Australia
  • 2Victorian Hand Surgery Associates, Fitzroy VIC, Australia
  • 3Division of Hand Surgery, Department of Plastic Surgery, St Vincent's Hospital, Fitzroy VIC, Australia
Further Information

Publication History

18 October 2016

27 March 2017

Publication Date:
21 April 2017 (eFirst)


Background The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon.

Purpose To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series.

Patients and Methods A consecutive series of seven patients underwent RCE and 4CF over a 2-year period, for basal thumb osteoarthritis with concurrent degenerative midcarpal wrist arthritis. Six patients were available for review. All six patients were women with a mean age of 73 years (range: 67–78; SD 4.6). Mean follow-up time was 48.2 months (34–59 months). Radiographic and clinical outcomes were recorded for all patients, to include wrist range of motion, key pinch, grip strength, and patient-rated wrist evaluation (PRWE).

Results There were no failures or revision procedures. The mean range of motion was flexion of 40 degrees (range: 30–40 degrees), extension of 30 degrees (range: 20–42 degrees), radial deviation of 18 degrees (range: 10–30 degrees), and ulnar deviation of 15 degrees (range: 0–25 degrees). The mean key pinch was 4.2 kg (range: 0.5–10, SD ± 3.5) and mean grip strength was 9.4 kg (range: 0–19, SD ± 8.9). The PRWE results in four patients were within normal values.

Conclusion RCE with 4CF resulted in acceptable clinical outcomes in four of six patients treated, with no failures at a mean follow-up of 48.2 months.

Level of Evidence Level IV, therapeutic study.


This study was performed at Victorian Hand Surgery Associates. This study has been granted ethics approval by the St. Vincent's Hospital Melbourne Human Research Ethics Committee, HREC No. HREC/16/SVHM/113.