Early motion following 4-corner arthrodesis using cannulated compression screws: a biomechanical study.

Abstract

To assess the ability of headless compression screws to maintain immobile bony contact throughout wrist cycling following simulated 4-corner arthrodesis. Our hypothesis was that the screw constructs would not permit displacement of the carpal bones and, therefore, could tolerate early postoperative range of motion in vivo. Using 6 matched-paired cadaveric arms, 4-corner arthrodesis was performed using an all-cannulated compression screw construct (capitolunate, lunotriquetral, and triquetrohamate screws) or a partial compression screw combined with partial K-wire construct (2 crossing capitolunate screws with the lunotriquetral and triquetrohamate interfaces immobilized with 2 K-wires). Wrists were mounted and cycled 5,000 times. Intercarpal distances were measured at 0, 100, 1,000, and 5,000 cycles at fixed points of passive flexion. Because previously published studies considered intercarpal distances of greater than 1 mm as significant, we defined fixation failure as greater than 0.5 mm gapping. Neither screw construct showed any significant intercarpal gapping at any point during the experimental cycling (largest average intercarpal gapping was 0.2 mm). There were no significant differences between the constructs regarding gapping at any point. In this biomechanical model, cannulated compression screws effectively resist significant intercarpal gapping during early motion after 4-corner arthrodesis. This may allow for immediate postoperative range of motion. Early gentle range of motion may be possible immediately following 4-corner arthrodesis using a construct consisting of headless compression screws.