Abstract
Background Four corner fusion (4CF) can be performed using various techniques, each with its
own efficacy and complication profile. Kirschner wires (K-wires) are a reliable and
cost-effective method when performing 4CF.
Purpose The purpose of this study was to determine the union rate and complication profile
of utilizing K-wires when performing a 4CF.
Materials and Methods A retrospective chart review was performed studying patients who underwent 4CF from
a multisurgeon, single-institution database. Demographic data were collected, and
functional outcomes were recorded including wrist range of motion (ROM), fusion rates,
time to fusion, and complication rates. Continuous variables were compared via two-tailed
t-tests, numerical data via one-way analysis of variance tests, and categorical data
via Fisher's Exact test.
Results In total, 141 patients underwent 4CF with K-wire fixation with an overall nonunion
rate of 3.5% (5/141). Diabetics had a nonunion rate of 11% compared to 3% without
diabetes (p = 0.28). Wrist ROM was significantly greater in patients who achieved bony union
at 6 weeks after removal of hardware compared to the nonunion group (78.0 degrees ± 14.4
vs. 57.8 degrees ± 21.3, p < 0.05). There was no difference in wrist ROM between the two groups six months after
hardware removal. There were no pin-related complications that required revision surgery.
Conclusion 4CF utilizing K-wire fixation is a reproducible and cost-effective technique that
results in good patient outcomes including bony union and functional wrist ROM. Smoking
and diabetes did not significantly increase the risk of nonunion, and K-wire fixation
can successfully be used in these patient populations.
Level of Evidence Level IV (retrospective study).
Keywords
four corner fusion - partial wrist arthrodesis - surgical fixation - Kirschner wires
- nonunion - outcomes - safety - complications
