Two-Column Intercarpal Arthrodesis Using Headless Compression Screws

Abstract

Introduction

Two-column midcarpal arthrodesis (2CMA) after scaphoidectomy is a well-established procedure for treating advanced wrist arthritis, particularly scapholunate advanced collapse and scaphoid nonunion advanced collapse grade III wrists. This study evaluates the clinical and radiographic outcomes of 2CMA using headless compression screws (HCS) over a 21-year period.

Materials and Methods

From 2001 to 2022, 128 patients underwent 2CMA at two institutions. Preoperative arthroscopy was performed to confirm the integrity of the radiolunate joint. Outcomes were assessed using the Modified Mayo Wrist Score (MMWS), Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, Patient-Reported Wrist Evaluation (PRWE), and radiographic analysis. Statistical analyses were conducted to compare pre- and postoperative outcomes.

Results

At a mean follow-up of 45 months, patients demonstrated significant improvements in pain (Visual Analogue Scale at rest: 2.0–0.6; under stress: 8.0–2.0; p < 0.001) and functional scores (MMWS: 27–69; DASH: 73–37; PRWE: 79–26; p < 0.001). Wrist range of motion improved from 61 to 81 degrees (p < 0.001), and grip strength increased from 19 to 28 kg (58–83% of the contralateral side, p < 0.05). Radiographic bone fusion was confirmed in 99% of cases, with a low complication rate of 4%, including two cases of radiocarpal arthropathy requiring total wrist fusion.

Discussion

The 2CMA technique with HCS achieved excellent pain relief, improved functionality, and high rates of bone consolidation. Compared with traditional four-corner arthrodesis, this approach avoids unnecessary joint fusion, preserving partial wrist mobility. The complications observed were minor and effectively managed.

Conclusion

2CMA using HCS is a reliable technique for treating advanced wrist arthritis, providing durable pain relief, functional improvement, and high fusion rates. Further studies comparing this approach with other arthrodesis techniques are warranted.

Keywords

midcarpal arthrodesis - wrist arthritis - headless compression screws - scaphoidectomy - SLAC wrist - SNAC wrist - two-column arthrodesis

Publication History

Received: 31 December 2024

Accepted: 26 May 2025

Article published online:
23 June 2025

• References

• 1 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
• 2 Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg [Br] 1999; 24 (03) 307-315
• 3 Watson HK, Goodman ML, Johnson TR. Limited wrist arthrodesis. Part II: intercarpal and radiocarpal combinations. J Hand Surg Am 1981; 6 (03) 223-233
• 4 Krimmer H, Lanz U. Die mediokarpale Teilarthrodese des Handgelenks. Oper Orthop Traumatol 1996; 8 (03) 175-184
• 5 Hayes E, Cheng Y, Sauder D, Sims L. Four-corner arthrodesis with differing methods of osteosynthesis: a systematic review. J Hand Surg Am 2022; 47 (05) 477.e1-477.e9
• 6 Schindelar LE, Wang ML, Bednar JM, Miller AJ. Lunatocapitate and triquetrohamate arthrodeses for degenerative arthritis of the wrist: a midterm follow-up. Hand (N Y) 2023; 18 (2_suppl, suppl): 96S-101S
• 7 Solgård L, Gvozdenovic R. Single- and bicolumn limited intercarpal fusion: a solution for the SLAC or SNAC wrist. J Wrist Surg 2023; 13 (01) 16-23
• 8 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
• 9 Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
• 10 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
• 11 Fairplay T, Atzei A, Corradi M, Luchetti R, Cozzolino R, Schoenhuber R. Cross-cultural adaptation and validation of the Italian version of the patient-rated wrist/hand evaluation questionnaire. J Hand Surg Eur Vol 2012; 37 (09) 863-870
• 12 Padua R, Padua L, Ceccarelli E. et al. Italian version of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Cross-cultural adaptation and validation. J Hand Surg [Br] 2003; 28 (02) 179-186
• 13 Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 1995; 35 (01) 54-59
• 14 Luchetti R, Montanari S, Marcovici LL, Cozzolino R, Kakar S, Atzei A. Single-portal arthroscopy improves the assessment of radial-sided disorders of the wrist. J Wrist Surg 2024
• 15 Dunn JC, Polmear MM, Scanaliato JP, Orr JD, Nesti LJ. Capitolunate arthrodesis: a systematic review. J Hand Surg Am 2020; 45 (04) 365.e1-365.e10
• 16 Acar MA, Özdemir A, Eravsar E. Treatment outcomes of all arthroscopic 4-corner arthrodesis techniques with 2 headless screws. J Hand Surg Am 2023; 48 (12) 1278.e1-1278.e8
• 17 Baur EM. Arthroscopic-assisted partial wrist arthrodesis. Hand Clin 2017; 33 (04) 735-753
• 18 Ruas JS, Del Pinal F, Mazarrasa R. Dry arthroscopic 4-corner arthrodesis and other refinements to stay within a tourniquet time. Handchir Mikrochir Plast Chir 2020; 52 (05) 441-446
• 19 Mamede J, Castro Adeodato S, Aquino Leal R. Four-corner arthrodesis: description of surgical technique using headless retrograde crossed screws. Hand (N Y) 2018; 13 (02) 156-163
• 20 Shintani K, Kazuki K, Takamatsu K, Yoneda M, Uemura T. Limited wrist arthrodesis for scapholunate advanced collapse wrist: triangle fixation for four-corner fusion. J Hand Surg Asian Pac Vol 2016; 21 (02) 207-211
• 21 Gauci MO, Waitzenegger T, Chammas PE, Coulet B, Lazerges C, Chammas M. Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis. J Hand Surg Eur Vol 2020; 45 (07) 679-686
• 22 Sturzenegger M. [The dorsal approach to the wrist joint and the distal radius]. Z Unfchir Versichermed Berufskr 1989; 82 (02) 80-85
• 23 Fidanza A, Necozione S, Garagnani L. Does anterior plus posterior interosseus neurectomy lead to better outcomes than isolated posterior interosseus denervation in the treatment of chronic wrist pain? A systematic review of the literature and meta-analysis. EFORT Open Rev 2023; 8 (03) 110-116
• 24 Ozyurekoglu T, Turker T. Results of a method of 4-corner arthrodesis using headless compression screws. J Hand Surg Am 2012; 37 (03) 486-492
• 25 Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 450-457
• 26 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (02) 256-263
• 27 Draeger RW, Bynum Jr DK, Schaffer A, Patterson JMM. Bicolumnar intercarpal arthrodesis: minimum 2-year follow-up. J Hand Surg Am 2014; 39 (05) 888-894
• 28 Hundepool CA, Duraku LS, Quanjel TJM, Van Minnen LP, Jansen MC, Zuidam JM. Two-, three-, or four-corner arthrodesis for midcarpal osteoarthritis: a systematic review and meta-analysis. J Hand Surg Am 2023
• 29 Baur EM, Luchetti R. Treatment of complications of midcarpal joints arthritis. In: Management Of Complications in Common Hand and Wrist Procedures: Fessh Instructional Course Book 2021. Stuttgart, Germany: Georg Thieme Verlag; 2021: 152-157
• 30 Guidi M, Luchetti R, Besmens I, Rothenfluh E, Calcagni M. Wrist arthrolysis: a systematic review of open and arthroscopic techniques. J Wrist Surg 2021; 10 (06) 543-550
• 31 Undurraga S, Au K, Dobransky J, Gammon B. Scaphoid excision and bicolumnar carpal fusion with retrograde headless screws. J Wrist Surg 2021; 10 (03) 201-207
• 32 Andronic O, Nagy L, Burkhard MD. et al. Long-term outcomes of the four-corner fusion of the wrist: a systematic review. World J Orthop 2022; 13 (01) 112-121