Proximal Row Carpectomy vs Four Corner Fusion for Scapholunate (Slac) or Scaphoid Nonunion Advanced Collapse (Snac) Wrists: A Systematic Review of Outcomes

Abstract

Proximal row carpectomy (PRC) and scaphoid excision with four-corner fusion (4CF) are common motion-preserving, salvage procedures for the treatment of wrists with scaphoid nonunion (SNAC) or scapholunate advanced collapse (SLAC). A systematic review was undertaken to clarify controversies regarding which of these procedures has the better outcome. We collated 52 articles that examine outcomes for SNAC or SLAC patients undergoing PRC or 4CF. Although the lack of unbiased trials must be acknowledged, this systematic review confirms that both procedures give improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists. PRC may provide better postoperative range of movement and lacks the potential complications specific to 4CF (nonunion, hardware issues and dorsal impingement). However, the risk of subsequent osteoarthritis is significantly higher in PRC patients despite the majority being asymptomatic at the time of review. Grip strength, pain relief and subjective outcomes are similar in both treatment groups.

Extensor Tendon Rupture of the Index Finger Secondary to Avascular Necrosis of the Scaphoid: A Case Report

“…Both techniques achieve comparable grip strength, pain relief, and subjective outcomes. 5 In our patient, 4-corner fusion was performed to stabilise the capitolunate joint. Surgical correction of the excision scaphoid and 4-corner fusion may exaggerate radial instability of the floating trapezium.…”

“…[3][4][5] Anatomically, the EIP passes along the ulnar side of the scaphoid. Scaphoid injury usually does not affect the EIP.…”

Management of Complications of Wrist Arthroplasty and Wrist Fusion

“…Conversely, scaphocapitate arthrodesis is rarely used to treat arthritis, but rather to provide a functional result similar to treatment options for STT arthritis, allowing for its use in the reduction of the SL interval and for offloading the lunate in the treatment of Kienbock disease (19,20). Scaphoid excision with four-corner fusion can be used in treating scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) (21,22).…”

“…Because PRC is essentially used to address the same issues as four corner fusion, there have been a number of studies comparing outcomes of the two procedures with variable results (22,36,37).…”

Osteoarthritis of the Wrist

“…In a high demand wrist the loss of stability could become problematic and the four-corner arthrodesis may be the preferred technique in this patient. (Mulford, Ceulemans et al 2009) (Cohen and Kozin 2001;Dacho, Baumeister et al 2008;Bisneto, Freitas et al 2011). Other surgical techniques include denervation, total wrist fusion, wrist arthroplasty and variations of intercarpal arthrodeses.…”