Randomized clinical trial between proximal row carpectomy and the four-corner fusion for patients with stage II SNAC

Abstract

ObjectiveTo compare the outcomes of patients with stage II SNAC submitted to surgical treatment by proximal row carpectomy (PRC) or four-corner fusion (FCF).MethodTwenty-seven patients aged 18–59 years (mean 37.52 years) were included. Thirteen patients underwent PRC in Group A, and 14 underwent FCF of the wrist in Group B. Evaluations were made before and after surgery with follow-up between 45 and 73 months. Range of motion (ROM); pain assessment with a visual analog scale (VAS); grip strength; disability of the arm, shoulder, and hand (DASH); and return to work were evaluated.ResultsGroup A patients had 68.5% and Group B patients, 58.01% of the ROM of the contralateral side. The VAS score was 2.3 in Group A and 2.9 in Group B. Grip strength was 78.67% and 65.42%, respectively, relative to the side not affected. The DASH score was 11 for PRC and 13 for FCF. In Group A, 9/13 (69.23%) and in Group B, 8/14 (57.14%) patients are currently working. Complications were symptomatic osteoarthritis in the mid-carpal joint in Group A and loosening of a screw in Group B.ConclusionThe clinical and functional results do not present statistically significant differences for both analyzed methods.

Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis

“…Aita et al . reported one complication in each group 16 . One patient in the PRC group developed symptomatic radiocarpal osteoarthritis requiring total wrist arthrodesis, while one patient in the 4CF group developed a ‘pseudoarthrosis’ (non union of the intercarpal fusions) which did not require further intervention.…”

“…Study characteristics of the included trials including the interventions and comparators are provided in Table 1. Of the three included randomised controlled trials, two compared proximal row carpectomy with four corner fusion for post-traumatic osteoarthritis 15, 16 , while the remaining RCT compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis 17 . Table 2 details the basic demographics of the intervention and comparator groups, as well as the details about the outcome data provided.…”

“…As a result of the degree of heterogeneity in terms of study interventions and the incomplete outcome data, it was determined that a meta-analysis of the outcomes was not possible. We carried out a meta-analysis of adverse events for 4CF vs PRC, as these were reported by two trials 15, 16 and the forest plot of this data is shown in Figure 4. No significant difference was noted in the risk of adverse events between these two groups (risk ratio 3.08 95% CI 0.69-13.65).…”

Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes ® ): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation

“…They saw no significant differences in conversion rate to total wrist arthrodesis in the PRC group versus 4 CF group patients [37]. In overall conclusion of a randomized clinical trial comparing proximal row carpectomy and four-corner fusion, Aita et al resumed no significant statistical differences in clinical and functional results between both salvage procedures [38]. …”

“…In systematically researching current literature, it becomes obvious that there is a variety of studies seeing advantages and disadvantages for both procedures with consequently recommending either PCR or MCA [34] or seeing no statistical significant differences [38]. …”