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Related Experiment Video

Updated: Nov 2, 2025

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
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Proximal Row Carpectomy in Young Patients.

Eric R Wagner1, Laurel A Barras2, Chelsea Harstad2

  • 1Department of Orthopedic Surgery, Emory University, Atlanta, Georgia.

JBJS Essential Surgical Techniques
|June 14, 2021
PubMed
Summary

Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) are surgical options for wrist arthritis. A recent study found both comparable outcomes in patients under 45, with PRC offering better motion and fewer complications.

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Area of Science:

  • Orthopedic Surgery
  • Hand and Wrist Surgery
  • Musculoskeletal Research

Background:

  • Controversy exists regarding optimal treatment for early-stage wrist arthritis in young, active patients.
  • Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) are common motion-sparing procedures.
  • Limited high-level data and variable outcomes complicate treatment decisions for this demographic.

Purpose of the Study:

  • To compare the efficacy and outcomes of PRC versus 4CA in patients under 45 years old with wrist arthritis.
  • To provide a technique article detailing PRC for this specific patient population.

Main Methods:

  • A dorsal approach is utilized for wrist access.
  • The scaphoid, lunate, and triquetrum are excised en bloc while protecting the radioscapholunate ligament.

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  • Capsular and retinacular repair follows the excision.

    • Main Results:

    • A recent comparative study found PRC and 4CA had similar complication rates, pain, and functional outcomes.
    • Patients undergoing PRC experienced improved wrist motion and fewer complications.
    • 4CA demonstrated slightly lower rates of radiocarpal arthritis development.

    Conclusions:

    • Both PRC and 4CA are viable options for young, high-demand patients with wrist arthritis.
    • PRC may offer advantages in terms of motion and complication rates.
    • Further research is needed to fully elucidate long-term comparative results.