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

Abstract

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.

Long-Term Patient-Reported Outcomes following Proximal Row Carpectomy

“…23,25 The flexion-extension arc of motion (70 degrees) found in the current study fell within the range of values reported by other studies (53-109 degrees). 5,7,16,21,[23][24][25][26][27][29][30][31] Palmer et al showed that normal daily activities require a flexion-extension arc of 35 degrees. 32 However, according to…”

“…18 Prior studies suggest that patients with poor functional outcomes are significantly less likely to respond to questionnaire follow-up studies, which may have skewed our results in a positive direction. 19,20 Patients in the current study had similar QuickDASH and VAS Pain scores to previous studies, where QuickDASH scores range from 11 to 42.9 1,[3][4][5]7,8,15,16,[21][22][23][24][25][26] and VAS Pain scores range from 0.8 to 2.3. 1,5,16,17,[21][22][23][24][25][26][27] The PRWE score was even slightly better, ranging from 20 to 59.9 3,5,7,8,17,24,26,28 in previous studies.…”

“…19,20 Patients in the current study had similar QuickDASH and VAS Pain scores to previous studies, where QuickDASH scores range from 11 to 42.9 1,[3][4][5]7,8,15,16,[21][22][23][24][25][26] and VAS Pain scores range from 0.8 to 2.3. 1,5,16,17,[21][22][23][24][25][26][27] The PRWE score was even slightly better, ranging from 20 to 59.9 3,5,7,8,17,24,26,28 in previous studies. Salomon and Eaton introduced the idea of interposition of the dorsal capsular flap that is elevated during the approach.…”

“…6 However, some argue that the branches of the PIN are severed during a transverse dorsal capsular approach to perform a PRC and neurectomy is essentially being performed during the approach. 25 Consistent with this, similar wrist function and pain levels have been described in patients who underwent PRC without PIN neurectomy where a T-shaped or H-shaped capsular incision was used. 23,25 The flexion-extension arc of motion (70 degrees) found in the current study fell within the range of values reported by other studies (53-109 degrees).…”

“…25 Consistent with this, similar wrist function and pain levels have been described in patients who underwent PRC without PIN neurectomy where a T-shaped or H-shaped capsular incision was used. 23,25 The flexion-extension arc of motion (70 degrees) found in the current study fell within the range of values reported by other studies (53-109 degrees). 5,7,16,21,[23][24][25][26][27][29][30][31] Palmer et al showed that normal daily activities require a flexion-extension arc of 35 degrees.…”