Arthroscopy-Assisted Four-Corner Arthrodesis: A Simplified and Reproducible Minimally Invasive Technique

Four-corner arthrodesis is an established motion-preserving salvage procedure for advanced degenerative wrist conditions, including scapholunate advanced collapse and scaphoid nonunion advanced collapse. Arthroscopy-assisted techniques have been introduced to reduce soft-tissue disruption and preserve capsuloligamentous structures; however, their technical complexity has limited widespread adoption. This article describes a simplified arthroscopy-assisted technique for four-corner arthrodesis designed to facilitate surgical execution while maintaining the biological advantages of minimally invasive surgery. The procedure is based on 4 key principles: complete arthroscopic scaphoid release to allow controlled, minimally invasive volar excision; preservation of midcarpal congruence during chondral preparation; restoration of carpal alignment by correcting the lunate-capitate axis under fluoroscopic guidance; and stable fixation with a triangular configuration of intercarpal compression screws. The technique is presented in a stepwise manner, including arthroscopic joint preparation, minimally invasive scaphoid excision, retrograde guidewire positioning, correction of dorsal intercalated segment instability deformity, and final intercarpal fixation. Illustrative clinical cases demonstrated technical feasibility, radiographic consolidation, and maintenance of functional wrist motion. This technique represents a practical arthroscopy-assisted alternative for four-corner arthrodesis and may help simplify key technical steps of minimally invasive wrist fusion procedures.