{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T09:20:04Z","timestamp":1754558404736,"version":"3.40.3"},"reference-count":37,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Wrist Surg"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Four corner fusion (4CF) can be performed using various techniques, each with its own efficacy and complication profile. Kirschner wires (K-wires) are a reliable and cost-effective method when performing 4CF.<\/jats:p><jats:p>\n          Purpose\u2003The purpose of this study was to determine the union rate and complication profile of utilizing K-wires when performing a 4CF.<\/jats:p><jats:p>\n          Materials and Methods\u2003A retrospective chart review was performed studying patients who underwent 4CF from a multisurgeon, single-institution database. Demographic data were collected, and functional outcomes were recorded including wrist range of motion (ROM), fusion rates, time to fusion, and complication rates. Continuous variables were compared via two-tailed t-tests, numerical data via one-way analysis of variance tests, and categorical data via Fisher's Exact test.<\/jats:p><jats:p>\n          Results\u2003In total, 141 patients underwent 4CF with K-wire fixation with an overall nonunion rate of 3.5% (5\/141). Diabetics had a nonunion rate of 11% compared to 3% without diabetes (p\u2009=\u20090.28). Wrist ROM was significantly greater in patients who achieved bony union at 6 weeks after removal of hardware compared to the nonunion group (78.0\u2009degrees\u2009\u00b1\u200914.4 vs. 57.8\u2009degrees\u2009\u00b1\u200921.3, p\u2009&lt;\u20090.05). There was no difference in wrist ROM between the two groups six months after hardware removal. There were no pin-related complications that required revision surgery.<\/jats:p><jats:p>\n          Conclusion\u20034CF utilizing K-wire fixation is a reproducible and cost-effective technique that results in good patient outcomes including bony union and functional wrist ROM. Smoking and diabetes did not significantly increase the risk of nonunion, and K-wire fixation can successfully be used in these patient populations.<\/jats:p><jats:p>\n          Level of Evidence\u2003Level IV (retrospective study).<\/jats:p>","DOI":"10.1055\/s-0043-1778084","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T23:42:31Z","timestamp":1706226151000},"page":"121-127","source":"Crossref","is-referenced-by-count":1,"title":["The Complication and Safety Profile of Utilizing Kirschner Wires in Four Corner Fusions"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1578-0989","authenticated-orcid":false,"given":"Shelby R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karan","family":"Dua","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W.","family":"Wysocki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John J.","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark S.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier C.","family":"Simcock","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,1,25]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1186\/s12891-019-2902-8","article-title":"Wrist pain: a systematic review of prevalence and risk factors\u2014what is the role of occupation and activity?","volume":"20","author":"R Ferguson","year":"2019","journal-title":"BMC Musculoskelet Disord"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.otsr.2014.06.025","article-title":"Wrist osteoarthritis","volume":"101","author":"J Laulan","year":"2015","journal-title":"Orthop Traumatol Surg Res"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S0363-5023(81)80074-3","article-title":"Limited wrist arthrodesis. Part II: intercarpal and radiocarpal combinations","volume":"6","author":"H K Watson","year":"1981","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/1753193408100954","article-title":"Proximal row carpectomy vs four corner fusion for scapholunate (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrists: a systematic review of outcomes","volume":"34","author":"J S Mulford","year":"2009","journal-title":"J Hand Surg Eur Vol"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1053\/jhsu.2001.20160","article-title":"Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis","volume":"26","author":"M S Cohen","year":"2001","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1055\/s-0032-1329616","article-title":"Long-term results after midcarpal arthrodesis","volume":"1","author":"F Neubrech","year":"2012","journal-title":"J Wrist Surg"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1177\/1753193414554359","article-title":"Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review","volume":"40","author":"B M Saltzman","year":"2015","journal-title":"J Hand Surg Eur Vol"},{"issue":"07","key":"ref8","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.jhsa.2014.12.035","article-title":"Four-corner arthrodesis versus proximal row carpectomy: a retrospective study with a mean follow-up of 17 years","volume":"40","author":"M JL Berkhout","year":"2015","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/BTH.0b013e31828d6070","article-title":"Exclusion of the hamate in 4-corner fusion: technique and outcomes of a novel approach to intercarpal arthrodesis","volume":"17","author":"L J Korus","year":"2013","journal-title":"Tech Hand Up Extrem Surg"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11552-014-9617-y","article-title":"Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes","volume":"9","author":"B Rudnick","year":"2014","journal-title":"Hand (N Y)"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1177\/1558944716681949","article-title":"Ten-year minimum follow-up of 4-corner fusion for SLAC and SNAC wrist","volume":"12","author":"P Traverso","year":"2017","journal-title":"Hand (N Y)"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s00264-020-04570-5","article-title":"Scaphoid excision with lunatocapitate fusion for the treatment of scaphoid nonunion with advanced collapsed wrist","volume":"44","author":"A M Abdelaziz","year":"2020","journal-title":"Int Orthop"},{"issue":"05","key":"ref13","first-page":"574","article-title":"Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC","volume":"51","author":"M A Aita","year":"2016","journal-title":"Rev Bras Ortop"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00590-016-1824-5","article-title":"Four-corner fusion of the wrist: clinical and radiographic outcome of 31 patients","volume":"26","author":"A F Mavrogenis","year":"2016","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"02","key":"ref15","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/01.prs.0000227737.90007.5d","article-title":"A prospective outcomes study of four-corner wrist arthrodesis using a circular limited wrist fusion plate for stage II scapholunate advanced collapse wrist deformity","volume":"118","author":"K C Chung","year":"2006","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"102886","DOI":"10.1016\/j.otsr.2021.102886","article-title":"Four-corner fusion: clinical and radiological outcome after fixation by headless compression screws or dorsal locking plate at minimum 5 years' follow-up","volume":"107","author":"M A d'Almeida","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"issue":"04","key":"ref17","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/01.bth.0000231581.70524.0c","article-title":"Three-corner wrist fusion using memory staples","volume":"10","author":"R P van Riet","year":"2006","journal-title":"Tech Hand Up Extrem Surg"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/S0363-5023(84)80223-3","article-title":"The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis","volume":"9","author":"H K Watson","year":"1984","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jhsa.2003.11.009","article-title":"Palmar midcarpal instability: the results of treatment with 4-corner arthrodesis","volume":"29","author":"C A Goldfarb","year":"2004","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1097\/BTH.0b013e31815e4580","article-title":"Spider plate fixation: no significant improvement in limited wrist arthrodesis","volume":"12","author":"E D Collins","year":"2008","journal-title":"Tech Hand Up Extrem Surg"},{"issue":"02","key":"ref21","first-page":"98","article-title":"[Midcarpal fusion with the spider plate]","volume":"23","author":"R Friedel","year":"2011","journal-title":"Oper Orthop Traumatol"},{"issue":"04","key":"ref22","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1054\/jhsb.2001.0598","article-title":"A modified technique of four-bone fusion for advanced carpal collapse (SLAC\/SNAC wrist)","volume":"26","author":"A Garcia-L\u00f3pez","year":"2001","journal-title":"J Hand Surg [Br]"},{"issue":"01","key":"ref23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1055\/s-0032-1323640","article-title":"Variable angle locking intercarpal fusion system for four-corner arthrodesis: indications and surgical technique","volume":"1","author":"J Gonz\u00e1lez Del Pino","year":"2012","journal-title":"J Wrist Surg"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1142\/S0218810413500263","article-title":"Outcomes of four-corner arthrodesis using the Hubcap circular plate","volume":"18","author":"S K Khan","year":"2013","journal-title":"Hand Surg"},{"issue":"03","key":"ref25","first-page":"183","article-title":"[Midcarpal arthrodesis with cortical bolting chip for treatment of grade II\/III scaphoid non-union and scapholunate advanced collapse]","volume":"41","author":"P H Zeplin","year":"2009","journal-title":"Handchir Mikrochir Plast Chir"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1177\/1753193416676663","article-title":"Four-corner arthrodesis employing the native scaphoid as the principal donor graft for advanced collapse deformity of the wrist: technique and outcomes","volume":"42","author":"S M Koehler","year":"2017","journal-title":"J Hand Surg Eur Vol"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1016\/0363-5023(94)90177-5","article-title":"Scapholunate advanced collapse wrist salvage","volume":"19","author":"D Ashmead IV","year":"1994","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref28","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/S0363-5023(05)80144-3","article-title":"Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis","volume":"20","author":"J D Wyrick","year":"1995","journal-title":"J Hand Surg Am"},{"issue":"10","key":"ref29","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.bjps.2007.08.007","article-title":"Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II","volume":"61","author":"A K Dacho","year":"2008","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"477.e1","DOI":"10.1016\/j.jhsa.2021.06.002","article-title":"Four-corner arthrodesis with differing methods of osteosynthesis: a systematic review","volume":"47","author":"E Hayes","year":"2022","journal-title":"J Hand Surg Am"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.bjps.2018.12.033","article-title":"Four-corner fusion: comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations","volume":"72","author":"H C Erne","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"02","key":"ref32","first-page":"332","article-title":"Four-corner arthrodesis using two headless compression screws","volume":"82","author":"S D Iordache","year":"2016","journal-title":"Acta Orthop Belg"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/1558944717702468","article-title":"Four-corner arthrodesis: description of surgical technique using headless retrograde crossed screws","volume":"13","author":"J Mamede","year":"2018","journal-title":"Hand (N Y)"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jhsa.2011.12.022","article-title":"Results of a method of 4-corner arthrodesis using headless compression screws","volume":"37","author":"T Ozyurekoglu","year":"2012","journal-title":"J Hand Surg Am"},{"issue":"03","key":"ref35","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1055\/s-0039-1678673","article-title":"The learning curve and pitfalls of arthroscopic four-corner arthrodesis","volume":"8","author":"A Vihanto","year":"2019","journal-title":"J Wrist Surg"},{"issue":"09","key":"ref36","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s004020100279","article-title":"Complications of K-wire fixation of fractures and dislocations in the hand and wrist","volume":"121","author":"S Stahl","year":"2001","journal-title":"Arch Orthop Trauma Surg"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.bjps.2011.09.043","article-title":"Four-corner arthrodesis\u2014does the source of graft affect bony union rate? Iliac crest versus distal radius bone graft","volume":"65","author":"H B Kitzinger","year":"2012","journal-title":"J Plast Reconstr Aesthet Surg"}],"container-title":["Journal of Wrist Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1778084.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T02:22:11Z","timestamp":1742955731000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1778084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,25]]},"references-count":37,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2025,3,25]]},"published-print":{"date-parts":[[2025,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1778084","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2163-3916","2163-3924"],"issn-type":[{"type":"print","value":"2163-3916"},{"type":"electronic","value":"2163-3924"}],"subject":[],"published":{"date-parts":[[2024,1,25]]}}}