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Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis—A Retrospective Comparative Study with Minimum 2 Years of Follow-up

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Abstract

Purpose

Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II–III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint.

Materials and Methods

Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius.

Results

A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared.

Conclusions

The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome.

Level of Evidence

Level III, Retrospective comparative study.

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Data availability statement

Informed consent was obtained from the patients. The data were available because all patients were included in the usual post-operative follow-up.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100, Savona, Italy

    Andrea Zoccolan, Maria Concetta Rivellino & Davide Greco

  2. Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy

    Emilio Ferrari, Federico Vitali, Chiara Ursino, Irene Zotta & Matteo Formica

  3. APSS Santa Chiara, Largo Medaglie d’oro, 9, 38122, Trento, Italy

    Irene Zotta

Authors
  1. Andrea Zoccolan
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  2. Emilio Ferrari
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  4. Chiara Ursino
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  5. Irene Zotta
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  6. Maria Concetta Rivellino
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Contributions

AZ was main surgeon and reviewed the final manuscript. EF visited the patients and contributed to fill and complete the database. FV visited the patients and contributed to fill and completed the database. CU researched the literature and performed the data analysis. IZ researched the literature and wrote part of the manuscript. MCR researched the literature and wrote part of the manuscript. DG was main surgeon and reviewed the final manuscript. MF reviewed the final manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Irene Zotta.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Not required for this study for it comprises a retrospective analysis of routinely acquired data. The article is conform to the Declaration of Helsinki.

Informed Consent

Written informed consent was obtained from all subjects before the study. Investigation performed at Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100, Savona, Italy.

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Zoccolan, A., Ferrari, E., Vitali, F. et al. Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis—A Retrospective Comparative Study with Minimum 2 Years of Follow-up. JOIO (2024). https://doi.org/10.1007/s43465-024-01127-1

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