Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients

Wagner, Eric R.; Bravo, Dalibel; Elhassan, Bassem T.; Moran, Steven L.

doi:10.1177/1753193415597096

Cited by 37 publications

(27 citation statements)

References 39 publications

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“…1,2 In order to obtain rapid recovery, some authors prefer to combine PRC with posterior interosseous nerve (PIN) resection. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Review of the literature revealed several studies reporting the benefits of such combination (3)(4)(5). However, all of the studies on this subject were case series 1,3,[5][6][7][8][9][10][11] or studies comparing PRC and PIN neurectomy with other procedures, such as limited carpal fusions [12][13][14][15] capsule interposition arthroplasty, 16 or rehabilitation protocols.…”

Section: Introductionmentioning

confidence: 99%

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders—A Comparative Study With Systematic Review of the Literature

et al. 2019

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Background: Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well. Objectives: We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. Methods: Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n ¼ 7) and with PIN neurectomy (group 2, n ¼ 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/ radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination. Results: There were no significant difference between the groups in regard with age (P ¼ .463), follow-up period (P ¼ .728), the ranges of flexion-extension (P ¼ .431) and radio-ulnar deviation (P ¼ .689), Q-DASH (P ¼ .452), and MAYO scores (P ¼ .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. Conclusion: According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.

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Section: Introductionmentioning

confidence: 99%

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders—A Comparative Study With Systematic Review of the Literature

et al. 2019

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“…22 In addition, Wagner et al reported reduced pain, improved functional outcomes, and a higher rate of wrist joint preservation in patients with arthritis who underwent a proximal row carpectomy and a concomitant neurectomy procedure. 23 However, in our study, it may be argued that the PIN is denervated by performing the TWF itself.…”

Section: Discussionmentioning

confidence: 63%

Complications and Factors Associated with Reoperation following Total Wrist Fusion

et al. 2020

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Background Total wrist fusion can be elected to relieve pain in patients with osteoarthritis and rheumatoid arthritis. This study aimed to investigate the overall complications and the factors associated with reoperation and soft tissue complication after total wrist fusion. Methods We retrospectively identified adult patients who underwent total wrist fusion using Current Procedural Terminology (CPT) codes, International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) and verified these by medical chart review. We included patients (n = 215) who were treated at a single institutional system from January 1, 2002 to January 1, 2019. The mean age was 53.3 ± 15.0 years and the median follow-up was 6.1 years (interquartile range [IQR] =1.7–9.0). The most common indications for wrist fusion included inflammatory arthritis (n = 66, 31%), degenerative arthritis (n = 59, 27%), and posttraumatic arthritis (n = 47, 22%). All wrist fusions were performed using a dorsal fusion plate or dorsal spanning plate, either with a local autograft (n = 167, 78%), iliac crest autograft (n = 2, 1.0%), allograft (n = 7, 3.3%), a combination of both (n = 16, 7.4%), or without a graft (n = 23, 11%). We performed a multivariable logistic regression to evaluate factors associated with reoperation. In addition, we performed a similar analysis to identify the factors associated with soft tissue complication after total wrist fusion. Results Forty-one (19%) patients underwent reoperation at a median of 6.9 months (IQR = 3.9–18). The indications included symptomatic implants (n = 12, 27%), implant failures (n = 8, 20%), infections (n = 7, 17%), and nonunions (n = 6, 15%). In multivariable analysis, total wrist fusion of the dominant hand (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.1–4.7, p = 0.033) was associated with a higher reoperation rate. Soft tissue complications occurred in 20 patients (9.3%) consisting of hematomas (n = 8, 3.7%), observed blistering (n = 5, 2.3%), and observed wound dehiscence (n = 4, 1.9%). In multivariable analysis, smoking (OR: 2.5, CI: 0.95–6.4, p = 0.010) was independently associated with soft tissue complication after total wrist fusion. Seventy-two (33%) patients had a postoperative complication including symptomatic hardware (n = 16, 7.4%), implant failure (n = 11, 5.1%), infection (n = 11, 5.1%), nonunion (n = 8, 3.7%), and carpal tunnel syndrome (n = 4, 1.9%). Conclusion Roughly one-third (33%) of the patients undergoing total wrist fusion experience a postoperative complication and 19% of the patients underwent a reoperation. Total wrist fusion of the dominant hand results in higher reoperation rates. The risk of a soft tissue complication after total wrist fusion is increased in smokers.

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“…Another long follow-up study of PRC for Kienb€ ock disease reported that 17 of 144 patients (12%) required revision surgery. 21 In our study, all patients were relieved from wrist pain and had no additional surgery, although the cohort did not include stage IV patients and had a smaller number of patients compared with the study of Croog and Stern. 20,21 Vascularized bone graft followed by CS with or without RS increased GS, reduced wrist pain, and enabled all patients to return to their jobs within 11 months after surgery.…”

Section: Discussionmentioning

confidence: 93%

Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years

Kakinoki

Nishichi

Ikeguchi

et al. 2020

Journal of Hand Surgery Global Online

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Purpose: This study aimed to report the outcomes of patients with stage III Kienb€ ock disease after treatment with a vascularized bone graft (VBG) to the lunate combined with capitate shortening osteotomy (CS) after a more than 10-year follow-up. Methods: A VBG to the lunate was combined with CS in 10 patients with stage III Kienb€ ock disease (6 patients with stage IIIA and 4 with stage IIIB). We performed VBG, CS, and radial shortening osteotomy (RS) on 7 patients. Among them, 4 had undergone RS previously. The passive wrist extension angle and wrist flexion angle, grip strength (GS), carpal height ratio, Stahl index, visual analog scale of wrist pain, and Mayo modified wrist score were assessed before surgery and at the final follow-up. Results: The flexion angle decreased markedly after surgery, when GS increased in all 10 patients. Radiographic examinations revealed that the carpal height ratio decreased in 9 of 10 patients, whereas the Stahl index increased in 8 patients and remained unchanged in 2. The oldest 3 of 7 patients who underwent VBG, CS, and RS exhibited fusion of the proximal carpals except the pisiform. The mean visual analog scale decreased from 27.6 before surgery to 5.7 afterward. The Mayo modified wrist score improved in 9 patients after surgery and remained unchanged in one. Conclusions: In stage III Kienb€ ock disease, VBG to the lunate combined with CS relieved wrist pain and increased GS and lunate height but was followed by severely restricted wrist motion. Fusion of the proximal carpals developed in 3 of 7 patients who received VBG with CS and RS.

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Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients

Abstract: III, Prognostic.

Cited by 37 publications

References 39 publications

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders—A Comparative Study With Systematic Review of the Literature

No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders—A Comparative Study With Systematic Review of the Literature

Complications and Factors Associated with Reoperation following Total Wrist Fusion

Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years

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