Non-union scaphoid: Four-corner fusion of the wrist

Background: Four-corner fusion of the wrist is an option for management of non-union scaphoid with painful arthritis of the wrist. Various surgical techniques have been devised for four-corner fusion, with inconsistent results. We present our experience of four-corner fusion achieved using a standard H-plate, designed originally for anterior cervical plating. Materials and Methods: The study is a retrospective analysis of six cases of painful wrist arthritis resulting from nonunion of scaphoid treated by four-corner fusion, between 1996 and 2004. The average duration of follow-up was 5.8 years. Each patient was evaluated clinically according to the rating scales described by Bach. Results: The mean grip-strength calculated as a percentage of the uninvolved side was 47% pre-operatively, and 74% post-operatively at the final follow-up. The difference between the preoperative and postoperative ′pain ratings′ and ′activity ratings′ was found to be statistically significant (P< 0.001). Mean time to fusion was 16.1 weeks. Dorsal impingement was the most common associated problem. Conclusions: H-plate, used for four-corner fusion, provides rigid fixation, ensures fusion, and is a good alternative to the available options.