Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study

Abstract

OBJECTIVE:To compare the functional results of carpectomy and four‐corner fusion surgical procedures for treating osteoarthrosis following carpal trauma.METHODS:In this prospective randomized study, 20 patients underwent proximal row carpectomy or four‐corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients.RESULTS:Both proximal row carpectomy and four‐corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant.CONCLUSIONS:Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non‐union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.

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

“…The data for pronation and supination were not used because the present authors believe that the distal radioulnar joint is not affected in this pathology, which is also corroborated by other authors 1, 2, 3. When the results of hand grip strength in Group A in the present study (78.67% of the normal side) are compared with the literature, Tomaino et al 4 observed 96%; Wryick et al, 5 94%; Cohen and Kozin, 6 71%; Bisneto et al, 9 47%; Imbriglia, 18 80%; Didonna et al, 27 91%; and Jebson et al, 28 83%. In Group B, the hand grip strength was 65.42% of the unaffected side; Tomaino et al, 4 observed 81%; Wryick et al, 5 74%; Cohen e Kozin, 6 79%; Bisneto et al, 9 73%; and Kendall et al, 21 56%.…”

“…When comparing both methods, the literature4, 5, 6, 7, 8, 12 presents a slight superiority in all analyzed functional parameters of patients undergoing PRC, except for the studies by Cohen and Kozin 6 and by Bisneto et al, 9 who observed better hand grip strength results for patients undergoing FCF.…”

“…Most studies using FCF for the treatment of osteoarthritis did not standardize the wrist osteosynthesis technique for fixation of the four corners (which combines the use of Kirschner wires, compression bolts, or circular plates). Of the aforementioned studies, only one was randomized 9 ; nevertheless, it did not standardize the initial pathology that progressed to carpal collapse. One study 10 included only patients with SLAC and had shorter hospital stay and lower complication rate in favor of PRC; those authors suggested the use of this procedure for stages I and II .…”

“…These surveys show no scientific evidence,4, 5, 6, 7, 8 since they are retrospective studies, non-randomized, and include other degenerative diseases of the carpus, such as post-traumatic osteoarthritis of the wrist, Kienböck disease, and scapholunate advanced collapse (SLAC). Other randomized studies 9 that addressed the same conditions other than SNAC 10 were also non-conclusive.…”

Wrist salvage procedures alter moment arms of the primary wrist muscles

“…Which salvage procedure has the best outcome is unclear. In particular, numerous studies have compared proximal row carpectomy (PRC) and scaphoid-excision four-corner fusion (SE4CF) [1–7]. Although several of these studies conclude that PRC preserves wrist range of motion, while SE4CF preserves grip strength [2, 3, 5], studies of long-term outcomes report that grip strength and wrist range of motion remain similarly and permanently impaired following both procedures [8–11].…”