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[Proximal row carpectomy: 25 cases].

F Lecomte1, G Wavreille, M Limousin

  • 1Service d'Orthopédie B, Chirurgie de la main et du membre supérieur, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille. fredericlecomte2002@yahoo.fr

Revue De Chirurgie Orthopedique Et Reparatrice De L'Appareil Moteur
|September 20, 2007
PubMed
Summary
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Proximal row carpectomy offers pain relief and improved function for advanced wrist collapse, but careful patient selection is crucial. This procedure is best reserved for cases where conservative treatments fail, particularly before significant cartilage damage occurs.

Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Wrist Biomechanics

Background:

  • Proximal row carpectomy (PRC) is a surgical option for advanced wrist collapse.
  • The development of alternative treatments necessitates a clearer understanding of PRC indications and outcomes.

Purpose of the Study:

  • To evaluate the clinical and radiological outcomes of proximal row carpectomy.
  • To identify optimal indications for PRC in patients with wrist collapse.

Main Methods:

  • A review of 25 patients who underwent PRC between 1999 and 2004.
  • Etiologies included scaphoid fracture, scapholunate dissociation, and Kienböck disease.
  • Clinical, radiological, and subjective outcomes were assessed at a mean 30-month follow-up.

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Main Results:

  • Significant improvement in pain (88%) and wrist function was observed.
  • Average flexion-extension was 60 degrees, and wrist force averaged 65% of the healthy side.
  • Outcomes in Kienböck disease patients were less favorable but not statistically significant compared to trauma patients.

Conclusions:

  • PRC is a palliative procedure for advanced wrist collapse when conservative options fail.
  • Indications should be limited to early stages (e.g., Watson grade II) to avoid capitate damage.
  • PRC may be preferred over four-bone arthrodesis due to lower complication risks, with specific considerations for Kienböck disease (Lichtmann III).