Use of the Triquetrum-Hamate Portal in Four-Corner Wrist Fusion: A Useful Technical Trick

Arthroscopy-assisted partial wrist-fusion techniques are becoming more popular nowadays. It became clearer that avoiding the violation of important ligament and tendinous structures – which is impossible when using the classic open techniques – enables a more biological approach, which is essential for faster healing and improvement in function. We describe the use of the triquetrum-hamate (TH) portal, which is seldomly applied in routine arthroscopic techniques for hand and wrist surgery, as an accessory portal to better perform anterior midcarpal debridement in four-corner fusion. This trick enables an almost complete anterior resection of the capitate and hamate chondral surfaces, increasing the subchondral osseous contact in the midcarpal joint after fixation, thus leading to higher consolidation rates.