Abstract / Summary
IntroductionScaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) are common patterns of progressive wrist arthritis.Scaphoid excision combined with four-corner arthrodesis (FCA) is a well-established motion-preserving procedure for stage II-III disease.While headless compression screw (HCS) fixation is widely used, the optimal screw configuration remains undefined. Materials and methodsThis retrospective cohort study evaluated patients with SNAC or SLAC wrists who underwent scaphoid excision and FCA with HCS fixation at a tertiary referral center between January 1, 2015, and December 31, 2024.Patients were categorized into two groups according to screw configuration: vertical or horizontal.The primary outcome was time to radiographic union.Secondary outcomes included union rate, carpal height ratio (CHR), joint space height ratio (JSHR), and postoperative complications. ResultsSixteen patients were included (eight patients in each group).All patients achieved radiographic union (100.0%).The mean time to union was 43.48 ± 12.91 days in the vertical group and 40.63 ± 11.70 days in the horizontal group, demonstrating no statistically significant difference (mean difference: 2.85 days, 95% CI: -10.42 to 16.12; t = -0.46,p = 0.66).Postoperative CHR and JSHR were maintained in both groups, with no significant differences between groups.No cases of hardware failure, infection, neurovascular injury, or reoperation occurred during follow-up. ConclusionsNo statistically significant differences in radiographic outcomes, time to union, or postoperative complication rates were observed between vertical and horizontal HCS configurations in FCA among patients with SNAC and SLAC wrists.These preliminary findings suggest that both orientations are feasible and can be selected based on patient carpal anatomy and surgeon preference.