[Functional results after proximal row carpectomy (PRC) in patients with SNAC-/SLAC-wrist stage II]

The proximal row carpectomy (PRC) is a motion preserving procedure which creates a new joint without arthrosis. It is a frequently used procedure in stage II of a posttraumatic degenerative arthrosis of the wrist after scaphoid nonunion or scapholunate ligament instability (SNAC-/SLAC-wrist). In this retrospective analysis the functional postoperative results of this operation are compared in light of a homogenous indication (SNAC-/SLAC-wrist stage II). In 38 patients PRC was performed for a stage II SNAC- (n = 29) or SLAC-wrist (n = 9) between June 1994 and March 2002. Postoperative examination included range of motion and grip strength. Pain was assessed using a visual analogue scale (VAS 0 - 100). The DASH questionnaire (disability of the arm, shoulder and hand) was used to evaluate the disabilities in activities of daily living (ADL). Thirty patients (79 %) with a mean age of 39 years (23 - 59) were evaluated with a mean follow-up of 27 months (6 - 100). Mean extension and flexion of the wrist reached 75 degree which was 57 % of the contralateral hand. Mean radial and ulnar deviation was 33 degree corresponding with 52 % of the contralateral hand. The average grip strength was 50 % of the unaffected side. The postoperative DASH score was 27.4. Pain with strenuous activity was reduced by 40 %, resting pain by 77 %. Three patients showed radiological signs of a radiocapitate arthrosis, one patient needed conversion into a complete wrist arthrodesis. Our results are in concordance with the literature. However, our follow-up time is relatively short and we cannot make any conclusion about the long-term outcome. PRC is a technically straightforward procedure for treatment of carpal collapse. For stage II of the SNAC-/SLAC-wrist we consider the resection of the proximal carpal row an alternative procedure to the midcarpal arthrodesis particularly in patients who require less grip strength and when a shorter postoperative immobilization is reasonable.