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DOI: 10.1055/s-0037-1604395
Long-Term Outcome and Secondary Operations after Proximal Row Carpectomy or Four-Corner Arthrodesis
Publication History
03 February 2017
26 June 2017
Publication Date:
27 July 2017 (online)
![](https://www.thieme-connect.de/media/jws/201801/lookinside/thumbnails/10-1055-s-0037-1604395_1700007-1.jpg)
Abstract
Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical procedures used to treat degenerative wrist conditions; however, complications and failures can occur.
Purpose This study aimed to investigate and compare the long-term rate of secondary surgeries including conversion to total wrist arthrodesis in patients who underwent PRC or FCA.
Materials and Methods A retrospective chart review of all patients who underwent PRC or FCA in the past 20 years at a tertiary referral institution and associated Veterans Affairs (VA) hospital was performed. Patient demographics, comorbidities, surgical indications, and associated complications were tabulated. Patients were contacted via phone to obtain additional follow-up information regarding any additional surgeries, 10-point visual analog scale (VAS) for pain, quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, hand dominance, and occupational data.
Results A total of 123 wrists made up the final dataset. Sixty-two wrists treated with PRC and 61 wrists treated with FCA were reviewed at a mean follow-up of 8.2 years. We did not find a significant difference in the rate of conversion to total wrist arthrodesis between the PRC (14.5%) and FCA (19.5%, p = 0.51) cohorts. Secondary operations were significantly greater in the FCA group (34.4%) compared with the PRC group (16.1%, p = 0.02). Females were 2.6 times more likely than males to undergo secondary operations when controlling for surgical procedure and smoking status (p = 0.04). We did not detect a significant difference in VAS pain or in quickDASH scores between the two groups (p = 0.35, 0.48, respectively).
Conclusion PRC and FCA have comparable patient reported outcomes and wrist arthrodesis conversion rates at a mean follow-up of 8.2 years. In contrast, the FCA patient group had a significantly higher rate of secondary operations, including those for nonunion, symptomatic hardware, and other implant-related issues, when combined with wrist arthrodesis conversion.
Level of Evidence Level IV, therapeutic study.
Note
This study protocol was approved by our institution's IRB.
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References
- 1 Stamm TT. Excision of the proximal row of the carpus. Proc R Soc Med 1944; 38 (02) 74-75
- 2 Rettig ME, Raskin KB. Long-term assessment of proximal row carpectomy for chronic perilunate dislocations. J Hand Surg Am 1999; 24 (06) 1231-1236
- 3 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (01) 94-104
- 4 Croog AS, Stern PJ. Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am 2008; 33 (07) 1122-1130
- 5 Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg Am 1994; 19 (05) 751-759
- 6 Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40 (05) 450-457
- 7 Zinberg EM, Chi Y. Proximal row carpectomy versus scaphoid excision and intercarpal arthrodesis: intraoperative assessment and procedure selection. J Hand Surg Am 2014; 39 (06) 1055-1062
- 8 Neviaser RJ. Proximal row carpectomy for posttraumatic disorders of the carpus. J Hand Surg Am 1983; 8 (03) 301-305
- 9 Jebson PJL, Hayes EP, Engber WD. Proximal row carpectomy: a minimum 10-year follow-up study. J Hand Surg Am 2003; 28 (04) 561-569
- 10 Wyrick JD. Proximal row carpectomy and intercarpal arthrodesis for the management of wrist arthritis. J Am Acad Orthop Surg 2003; 11 (04) 277-281
- 11 Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg 2008; 61 (10) 1210-1218
- 12 Vanhove W, De Vil J, Van Seymortier P, Boone B, Verdonk R. Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist. J Hand Surg Eur Vol 2008; 33 (02) 118-125
- 13 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (02) 256-263
- 14 Wall LB, Stern PJ. Proximal row carpectomy. Hand Clin 2013; 29 (01) 69-78
- 15 Berkhout MJ, Bachour Y, Zheng KH, Mullender MG, Strackee SD, Ritt MJ. Four-corner arthrodesis versus proximal row carpectomy: a retrospective study with a mean follow-up of 17 years. J Hand Surg Am 2015; 40 (07) 1349-1354
- 16 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (05) 719-725
- 17 Imbriglia JE, Broudy AS, Hagberg WC, McKernan D. Proximal row carpectomy: clinical evaluation. J Hand Surg Am 1990; 15 (03) 426-430
- 18 Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. J Hand Surg Eur Vol 2009; 34 (02) 256-263
- 19 Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am 1995; 20 (06) 965-970
- 20 Clendenin MB, Green DP. Arthrodesis of the wrist-complications and their management. J Hand Surg Am 1981; 6 (03) 253-257
- 21 Huskisson EC. Measurement of pain. Lancet 1974; 2 (7889): 1127-1131
- 22 Neviaser RJ. On resection of the proximal carpal row. Clin Orthop Relat Res 1986; (202) 12-15
- 23 Stern PJ, Agabegi SS, Kiefhaber TR, Didonna ML. Proximal row carpectomy. J Bone Joint Surg Am 2005; 87 (Pt 2, Suppl 1) 166-174
- 24 Shin AY. Four-corner arthrodesis. J Am Soc Surg Hand 2001; 1: 93-111
- 25 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
- 26 Adey L, Ring D, Jupiter JB. Health status after total wrist arthrodesis for posttraumatic arthritis. J Hand Surg Am 2005; 30 (05) 932-936
- 27 Vance MC, Hernandez JD, Didonna ML, Stern PJ. Complications and outcome of four-corner arthrodesis: circular plate fixation versus traditional techniques. J Hand Surg Am 2005; 30 (06) 1122-1127
- 28 Kendall CB, Brown TR, Millon SJ, Rudisill Jr LE, Sanders JL, Tanner SL. Results of four-corner arthrodesis using dorsal circular plate fixation. J Hand Surg Am 2005; 30 (05) 903-907
- 29 Chim H, Moran SL. Long-term outcomes of proximal row carpectomy: a systematic review of the literature. J Wrist Surg 2012; 1 (02) 141-148