Introduction and purpose: The most commonly found degenerative changes in the wrist can be included in two basic patterns of advanced carpal collapse: On the one hand scapholunate advanced collapse (SLAC) and on the other scaphoid nonunion advanced collapse (SNAC). To treat this collapse, Watson described the so-called four-corner arthrodesis, which includes the lunate, capitate, pisiform and hamate bones. The aim of this study is to assess the results obtained using fixation with a Spider plate.

Materials and methods: In this study we included a series of 20 patients that underwent 4-corner arthrodesis with a Spider plate. These cases had stage II or III advanced degeneration of the wrist both SLAC and SNAC. We have also used this technique for other indications such as osteochondral lesions of the head of the capitate, mediocarpal arthritis or mediocarpal instability.

Results: Mean follow-up was 16 (7–25) months. An important decrease in pain was seen in all cases and postoperative values were as follows: palmar flexion, 38° (range: 12–46); dorsal flexion, 30° (range: 12–45); radial deviation, 12° (range: 0–16); ulnar deviation, 24° (range: 15–40). An increase in fist force was seen after surgery. The arthrodesis healed in all cases, with a slight decrease in carpal height index after surgery.

Conclusions: This surgical technique has allowed us to obtain good results determined clinically and by means of X-rays, as well as early motion after surgery.


  • The abstracts were prepared by E. Carlos Rodríguez-Merchán, Editor-in-Chief of the Spanish Journal of Orthopaedic Surgery and Traumatology (Revista de Ortopedia y Traumatología). Correspondence should be addressed to him at: Sociedad Española de Cirugía Ortopédica y Traumatología, calle Fernández de los Ríos 108, 28015-Madrid, Spain