الفهرس 
Anatomy of the wristOnly 14 pages are availabe for public view
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Abstract
A stable and sufficiently pain-free wrist remains the goal for surgical treatments of posttraumatic degenerative arthrosis. If articular cartilage with congruent joint mobility is available motion-sparing procedures are superior to total wrist fusion.
Radioscaphoid arthritis is not uncommon problem which occures as a stage of development of carpal collapse multiple including scapholunate advanced collapse grade II, III scaphoid nonunion advanced collapse grade II, III and AVN of scaphoid grade III, IV.
The two most common motion-preserving surgical procedures for SLAC & SNAC wrist arthritis are scaphoid excision with four-corner fusion and proximal row carpectomy (PRC). advantages of PRC it is technically easier, early mobilization, and the lack of nonunion risk. PRC is more favourable for patients who require less grip strength at work and still in grade II SLAC & SNAC.
Potential disadvantages of PRC include shortening of the carpus, with associated weakness and incongruity between the capitate and the lunate fossa of the distal radius with more limitation of radio-ulner deviation. Moreover, PRC is not an option in treatment of stage III SLAC & SNAC when there is arthritis in capitate head
In management of SLAC & SNAC wrist arthritis four corner wrist fusion is superior to PRC regarding restoration of wrist stability and height, improvment of grip strength while providing more physiologic motion through the preserved radiolunate and ulnocarpal joints. For patients carrying out heavy manual work four corner fusion is recommended due to the significantly better grip strength postoperatively.
Biomechanical analysis determined that 63%–70% of wrist flexion-extension occurs at the radiocarpal joint and 30%– 36% occurs at the midcarpal joint. predicting up to 70% of the flexion extension arc after four-corner fusion.
A lot of controversies is still present about the different method of fixation of four corner fusion which include K wires, staples, headless screws and circular plates. Also, there was some controversy about the source of bone graft.
This study had concentrated on the role of the four corner wrist fusion using K wires in the treatment of the radioscaphoid arthritis. This study was conducted in the period between January 2009 and December 2011 involving 25 patients. Mean follow up was 18 months (12-30 month) radioscaphoid arthritis cases in this study was mainly due to (SNAC) and (SLAC).
Results were evaluated using Mayo pain score, Quick DASH score, Visual Pain Analogue Score, Modified Mayo Wrist score, in addition to the power grip and range of motion which were compared to the normal side and preoperative data.
All patients achieved radiological union after average 7.24 weeks, nonunion did not occurred in any case. Pain rating improved postoperative, The mean postoperative pain score was 22.0 points (preoperative pain score was 5.6). The mean postoperative VAS was 1.2 points (preoperative VAS was 5.96). The mean postoperative Grip Strength become 72.12% of normal side. Flexion–extension arc 12 months postoperative was 64.85% of normal side. The post operative Quick DASH Score improved with a mean of 14.34 point. Modified Mayo Wrist Score improved postoperative, The mean postoperative Score was 74.8 points.
The complication rate was (12%) in this study we can call them as minor complications, regarding that union achieved in all of our patients, no symptomatic dorsal radiocarpal impingment occurred and no deep wound infection.
This study results were encouraging when compared to other studies doing four corner fusion using different method of fixation including K wires and spider plate. Or other results doing proximal raw carpectomy as an alternative to four corner fusion.