Degenerative arthritis of the wrist: Proximal row carpectomy versus scaphoid excision and four-corner arthrodesis

Cohen, Mark S.; Kozin, Scott H.

doi:10.1053/jhsu.2001.20160

Cited by 271 publications

(225 citation statements)

References 24 publications

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“…This finding may help to explain why the clinical results after scaphoid excision and four-corner fusion and proximal row carpectomy are so comparable, as were reported by Cohen [3] and Wyrick [13].…”

Section: Discussionsupporting

confidence: 76%

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Skie¹,

Grothaus

Ciocanel

et al. 2007

Hand (New York, N,Y.)

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Purpose Partial wrist arthrodesis is a commonly performed procedure for the treatment of posttraumatic wrist arthritis because of its ability to provide pain relief without sacrificing complete wrist motion. The purpose of this study was to evaluate the redistribution of force after fourcorner fusion and scaphoid excision, and to correlate the findings with the reported clinical outcomes. Methods Fifteen cadaveric wrists were used to study the biomechanics of the four-corner fusion. Pressure-sensitive film (super-low-pressure-indicating film-Pressurex, Sensor Products Inc, Madison, NJ) was inserted into the radiocarpal joint. Using the MTS 858 Mini Bionix (MTS System, Eden Prairie, MN), 50-kg loads (220 N) were applied to the wrists before and after simulated four-corner fusion and scaphoid excision. Statistically, we compared the pressure in the normal (intact) wrists versus four-corner fusion and scaphoid excision. The pressure measurements across the scaphoid fossa, lunate fossa, and triangular fibrocartilage complex (TFCC) were compared. Results There is a statistical significant difference between scaphoid, lunate, and TFCC mean total force when pre and post-fusion were compared (p=0.0001). Our study revealed a statistical significant decrease in the mean scaphoid total force after scaphoid excision and four-corner fusion (p=0.0001). We also found a subsequent increase in mean total force after scaphoid excision and four-corner fusion for the lunate fossa that did not reach statistical significance (p=0.08), and no difference in load across the TFCC area (p=0.995). Conclusions Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion.

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Section: Discussionsupporting

confidence: 76%

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Skie¹,

Grothaus

Ciocanel

et al. 2007

Hand (New York, N,Y.)

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“…Static SL dissociation was seen on the left side in 2 patients and on the right side in 10 patients. The time from injury to surgery averaged 8 months (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The average follow-up period after surgery was 15.8 months (range: 13-34).…”

Section: Methodsmentioning

confidence: 99%

“…1 Patients with chronic static SL dissociation usually have complete detachment of the dorsal SL ligament with elongation of the secondary stabilizers. 5 Several surgical procedures have been recommended for the treatment of this stage of scapholunate dissociation, including limited arthrodesis, 6 capsulodesis, 7,8 tenodesis, 5 proximal row carpectomy, 9 and bone-ligament-bone reconstuction. 10 Blatt 7 described an indirect soft tissue reconstruction using a flap of wrist capsule based on the radius inserted into the distal pole of the scaphoid.…”

mentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

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“…Scaphoid excision combined with a four-bone fusion is an alternative motion-preserving treatment. However, the surgeon may have reasons to recommend a PRC: greater wrist motion, [18][19][20] shorter surgical time, shorter postoperative immobilization, and lack of the need to achieve bony union.…”

Section: Discussionmentioning

confidence: 99%

Technique: Osteochondral Grafting of Capitate Chondrosis in PRC

Tang

Imbriglia

2013

Jnl Wrist Surg

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Proximal row carpectomy (PRC) has been shown in multiple studies to be an effective motion-preserving procedure for wrist arthritis. The operation consists of resection of the scaphoid, lunate, and triquetrum. 1 The proximal capitate and lunate fossa of the radius form the new wrist articulation, which makes the ideal patient free of degenerative changes at those articular surfaces. 2-8 Various authors, as well as the senior author, have maintained that when there is mild degeneration of these articular surfaces, PRC can still provide good to excellent results. [2][3][4][5][6]9 However, as wrist arthritis progresses, as in stage III scapholunate advanced collapse (SLAC) wrist or stage II/III scaphoid nonunion advanced collapse (SNAC) wrist, the proximal capitate becomes arthritic. With advanced degeneration, alternative surgical procedures include scaphoid excision, four-bone fusion, and wrist fusion. However, there Keywords ► osteochondral graft ► proximal row carpectomy AbstractBackground Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre-and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated.

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Degenerative arthritis of the wrist: Proximal row carpectomy versus scaphoid excision and four-corner arthrodesis

Cited by 271 publications

References 24 publications

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Technique: Osteochondral Grafting of Capitate Chondrosis in PRC

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