Proximal row carpectomy—an adequate procedure in carpal collapse

Abstract

Proximal row carpectomy (PRC) is an established procedure in the treatment of advanced radiocarpal arthritis. The aim of this study was to evaluate the individual, functional and radiological results in relation to the initial diagnosis. Seventeen patients (15 men, two women), who had undergone PRC, were evaluated. Their average age at the time of the operation was 48 years (range 21-70 years). The most frequent diagnosis leading to PRC was scaphoid non-union advanced collapse (SNAC), which was observed in nine patients, while in three cases each the condition treated had been scapholunate advanced collapse (SLAC) and perilunate dislocation, and in two cases, Kienboeck's disease. At the time of the follow-up examination (median 65.41 months), a significant improvement in the range of movement was seen. While only four (36%) of the patients with SNAC had radiological signs of arthrosis of the radiocapitate joint, visible radiological involvement was noted in all patients who underwent PRC due to scapholunate dissociation and perilunate dislocation. The results of this study show that PRC is a good way of achieving long-term improvement of the degree of subjective freedom from symptoms and of the functional range of movement. Interruption of ligamentous structures, as in scapholunate dissociation and perilunate dislocation, seems to influence the radiological outcome.

Proximal row carpectomy: Long-term results

“…Overall, the pain relief from proximal row carpectomy is very satisfactory; because pain was the reason for consultation, the mean VAS of 1.2 displays the efficacy of the procedure [2,3,6,12,18,22,27,28]. Although the results in term of mobility (arc of mobility: 768 and 458) and of function (SWV: 76%) are encouraging, persistent pain in the extreme positions and weakness with repeated movements and rotation represent a handicap for the manual laborer [3].…”

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

“…Most commonly and best described in literature are the 4-corner fusion of the wrist and the proximal row carpectomy [1], [2], [3], [4], [5], [6], [7], [9], [10], [11], [13], [16], [18], [19], [31], [32], [33], [34], [35]. Nonetheless, some authors recommend the 3-corner fusion, bicolumnar intercarpal arthrodesis or other modifications as better options for treating wrist instabilities [14], [15].…”

“…Furthermore, Brinkhorst et al explored better functional outcomes (according to the Sollerman hand function test) of PCR patients comparing to those with MCA [36]. Additionally, there were specific complications for PCR and MCA mentioned in literature: On the one hand PCR can cause arthrosis in the radiocapitate region (particularly with necessity for denervation procedures), whereas on the other hand MCA may lead to insufficient cartilage removal, persisting pain, lower functional level postoperative, improper realignment of carpal height with nonunion in consequence (particularly with necessity for complete arthrodesis with loss of motion preserving keynote) [2], [4], [5], [9], [10], [11]. …”

“…Persisting scaphoid non-unions and scapholunate ligament ruptures are the main causes for developing an insufficiency in carpal joint structure (carpal collapse, named as scaphoid nonunion advanced collapse = SNAC wrist or scapholunate dissociation advanced collapse = SLAC wrist respectively) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Watson and Ryu classified the severity of degenerative changes into three stages as shown in Table 1 (Tab.…”

Proximal row carpectomy in emergency

“…_ 2 ) T D $ F I G ] patients. In a more recent series of 17 patients treated electively with a follow-up of five and a half years, Streich et al [19] showed radiographic arthritis in all PRC after scapholunate or perilunate dislocation. In our emergency group, four patients had normal radiocapitate articular space and two subchondral sclerosis.…”