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J Wrist Surg 2024; 13(01): 016-023
DOI: 10.1055/s-0043-1762932
Scientific Article

Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist

Lars Solgård 
1   Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
,
Robert Gvozdenovic 
1   Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
2   Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Funding This work was not supported by any public or private instances.
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Abstract

Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union.

Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35–79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0–100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included.

Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12–68). All patients but two achieved union at a mean of 9.5 weeks (range: 5–25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively (p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery (p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united.

Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals.

Level of Evidence Prospective, cohort study, level III.

Keywords

intercarpal fusion - lunocapitate fusion - two-column fusion - one-column fusion - four-corner fusion - headless compression screws - wrist pain - SLAC - SNAC

Ethical Approval

This study obtained approval, granted by the Danish Patients Safety Authority, following the Danish national regulations for the nonrandomized clinical studies.


Informed Consent

Written informed consent was obtained from all patients involved in this study.


Author Contributions

Both authors designed and conducted the study including patient recruitment and data collection. Both authors served as observers in the study. Mr. Gvozdenovic performed all data analysis.


Mr. Solgård prepared the manuscript draft with important intellectual inputs from Mr. Gvozdenovic. Both authors approved the final manuscript.




Publication History

Received: 13 September 2022

Accepted: 16 January 2023

Article published online:
03 March 2023

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