Full-size Left-side Hidden
FOUR-CORNER FUSION

Traditionally, four-corner fusion has been the recommended limited wrist fusion for SLAC wrist based on the large surface area available for fusion and its proven track record in published series. Scaphoid excision is typically performed in conjunction with the procedure. Other articles and chapters well describe the proper surgical technique, but the keys to the surgery include proper decortication of all bone surfaces, restoration of proper bone carpal alignment (specifically correction of the lunate extension and restoration of the collinear lunate-capitate relationship), and adequate postoperative immobilization.[6] Failure to properly decorticate all bony surfaces and failure to properly immobilize patients postoperatively can contribute to increased rates of nonunion. The published rate of nonunion varies considerably for four-corner fusions, but meta-analyses have shown a published mean of 4.3% to 8.4% overall.[7,8]Attention should be paid as well to the presence of …