Proximal row carpectomy: long-term results

To evaluate long-term clinical outcome of proximal carpectomy. Our assumption was that this intervention should result in long-term benefit, making a wrist painless, mobile, and functional, compatible with social and professional life, whatever the initial etiology of the degenerative wrist.

We report a continuous single centre retrospective series of 24 patients. Objective (mobility, strength, radiographic evaluation) and subjective (pain, subjective wrist value, functional scores) functions were assessed by an independent observer. Surgery was performed mainly for Kienbock's disease, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists.

The follow-up lasted 116 months in average, during which pain was improved in all cases; 83% of the patients were satisfied with a mean score of 1.2 on a visual analogue scale (VAS) and 76% subjective wrist value (SWV) (disabilities of the arm, shoulder and hand [DASH]: 31). Wrist flexion-extension arc averaged 76 degrees , and the grip strength equivalent to 78% of the contralateral limb. Radiographic modification developed in 52% without any clinical impact. Three patients required arthrodesis and never felt comfortable with their carpectomy.

Our study shows a long-term efficacy of proximal row carpectomy. This treatment must be considered in the therapeutic arsenal for a degenerative and painful wrist, and it should no longer be regarded as a salvage procedure. Advantages of this intervention are obvious: technical simplicity, short rehabilitation, immediate functionality of the wrist and few complications.