Scaphoid Excision and Four Corner Fusion Using Anti-Grade Headless Compression Screws in the Management of Stage I and II SNAC Wrists

Introduction: Scaphoid Nonunion Advanced Collapse (SNAC) is a common cause of traumatic wrist degeneration. Scaphoid excision and Four-Corner Fusion (4-CF) has been shown to be an effective treatment option to relieve pain and in the same time preserve a good functional range of wrist motion. In current study, we evaluated the functional outcome of 4-CF with excision of the Scaphoid for the treatment of stage II and III SNAC wrist fixed using two converging anti-grade headless compression screws. Methods: Between 2010 and 2017, 34 patients with SNAC stage II and III were managed by 4-CF, excision of the Scaphoid and fixation by two converging anti-grade headless compression screws. The modified Mayo wrist score system MMWS was used for clinical assessment. The average preoperative MMWS was 47.5 only patients with minimum follow up period 12 months were included in this study. Results: After an average final follow up of 43.24 months, solid union was achieved in all cases in an average time of 70.38 days. The average postoperative MMWS was 80. It was excellent in 8 patients (23.5%), good in 11 patients (32.4%), fair in 14 (41.2%) patients and poor in 1 (2.9%) patients. Conclusion: The 4-CF with excision of the Scaphoid using antigrade headless compression screws provides a reliable treatment option for advanced SNAC wrist stage II and III. Anti grade insertion of the screws did not have a deteriorative effect on the final outcome. This technique provides reliable functional outcome with a high rate of union and low rate of complication.