Union of Radiocarpal Fusion With and Without Proximal Row Carpectomy: A Systematic Review

Ruskin, Jeremy; Shah, Harsh; Congiusta, Dominick V.; Ahmed, Irfan; Vosbikian, Michael M.

doi:10.1016/j.jhsa.2020.09.019

Cited by 2 publications

(11 citation statements)

References 59 publications

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“…These results are in parallel with a recent systematic review by Ruskin et al, which demonstrated no statistically significant difference in TWA union rates when a PRC was included in the operation. 2 The nonunion rates in this study are substantially higher than previously reported rates of $5 to 8%. 2 Indications for TWA in the current study were similar to previous studies, as such there is no evidence that the patients included in this study were at an increased risk for the development of a nonunion.…”

Section: Discussioncontrasting

confidence: 69%

“…2 The nonunion rates in this study are substantially higher than previously reported rates of $5 to 8%. 2 Indications for TWA in the current study were similar to previous studies, as such there is no evidence that the patients included in this study were at an increased risk for the development of a nonunion. 11 Many prior studies on TWA union rates with and without PRC using a dorsal spanning plate do not include the third CMC joint in the fusion mass.…”

Section: Discussioncontrasting

confidence: 69%

“…2 However, the majority of studies included in their review were case series without a control group and their systematic review was underpowered to detect the expected difference in union rates. 2 The purpose of this study is to evaluate if TWA performed using a dorsal spanning plate with concomitant PRC improves union rates and decreases rates of hardware complications as compared with TWA performed without a concomitant PRC.…”

Section: Discussionmentioning

confidence: 99%

“…Using an equivalent greatest absolute difference in union rates of 98.3% for TWA þ PRC and 94.4% for TWA alone identified by Ruskin et al, an expected odds ratio (OR) for the power analysis was calculated as 0.29. 2 Assuming a logistic regression analysis, α ¼ 0.05, 1 À β ¼ 0.80, a binomial X distribution without other covariates, and X parm π ¼ 0.5 (assuming equal distribution among groups), the required sample size to detect an OR of 0.29 was calculated to be 754 (377 per group) using G Ã Power (G Ã Power version 3.1.9.7, Heinrich Heine-Universität Düsseldorf, Deutschland [Germany]). 19 Secondary outcomes were compared between the groups and by plate type using time to event survivorship methodology, including Kaplan-Meier's estimation and Cox's proportional hazards regression.…”

Section: Methodsmentioning

confidence: 99%

“…1,3 Another advantage of concomitant PRC is that the removed proximal carpal bones can be used for cancellous bone graft, which may obviate the need for a secondary incision or additional surgical site for bone graft harvest. 2 However, a theoretic concern with performing PRC is the loss of carpal height resulting in diminished flexor tendons excursion and grip strength. 1 In patients who have undergone TWA with dorsal spanning plates, union rates without PRC have been reported between 92 and 100%.…”

mentioning

confidence: 99%

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Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

et al. 2021

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Background Some surgeons advocate for concomitant proximal row carpectomy (PRC) with total wrist arthrodesis (TWA), though there are limited data to support or oppose this view. Questions/Purposes Does concomitant PRC improve rates of union, revision, hardware loosening, hardware failure, and hardware removal in TWA? Patients and Methods A retrospective cohort study of patients who underwent TWA with and without concomitant PRC between January 2008 and December 2018 was undertaken. Patients were included if they underwent TWA using a dorsal spanning plate. Patients were excluded if they underwent partial wrist arthrodesis, revision TWA, or TWA with nondorsal spanning plate fixation. Results A total of 183 wrists in 180 patients were included in the study, 96 (52.5%) in the TWA only and 87 (47.5%) in the TWA + PRC groups. Median clinical and radiographic follow-up was 18.0 months (3.0–133.0 months) in the TWA + PRC group and 18.5 months (2.0–126.0 months) in the TWA only group (p = 0.907). No difference in nonunion (TWA + PRC: 13/87 [14.9%], TWA only: 18/96 [18.8%], odds ratio: 0.76, p = 0.494), revision (TWA + PRC: 5/87 [5.75%], TWA only: 8/96 [8.33%], hazard ratio [HR]: 0.73, p = 0.586), loosening (TWA + PRC: 4/87 [4.60%], TWA only: 6/96 [6.25%], HR: 0.74, p = 0.646), failure (TWA + PRC: 5/87 [5.75%], TWA only: 4/96 [4.17%], HR: 1.55, p = 0.530), and removal (TWA + PRC: 12/87 [13.8%], TWA only: 16/96 [16.7%], HR: 0.84, p = 0.634) were identified. Conclusion Concomitant PRC might not improve rates of union or diminish complications in patient undergoing TWA. The role of PRC and the rationale for its use in TWA need to be individualized and discussed with patients prior to surgery. Level of Evidence This is a Level IV, therapeutic study.

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Section: Discussioncontrasting

confidence: 69%

Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

et al. 2021

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Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions

et al. 2023

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Background Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity. While its utility has been described for many other anatomical locations throughout the body, its use for the treatment of failed total wrist fusions has not been previously described in detail in the literature. Methods In this article, we outline in detail the surgical technique for MFC-CP flap for the management of recalcitrant aseptic nonunions following failed total wrist arthrodesis. We discuss indications and contraindications, pearls and pitfalls, and potential complications of this technique. Results Two illustrative cases are presented of patients with recalcitrant nonunions following multiple failed total wrist fusions. Conclusion When all avenues have been exhausted, a free vascularized corticoperiosteal flap from the MFC is a sound alternative solution to achieve union, especially when biological healing has been compromised. We have been able to achieve good clinical outcomes and reliable fusion in this difficult patient population.

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Union of Radiocarpal Fusion With and Without Proximal Row Carpectomy: A Systematic Review

Cited by 2 publications

References 59 publications

Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

Does Proximal Row Carpectomy Improve Union in Wrist Arthrodesis? A Retrospective Cohort Study

Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions

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