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The Effect of Proximal Row Carpectomy and Trapeziectomy on First Ray Stability: A Cadaveric Study
Charles Carlson1, Anxhela Nezha2, Grant Mathison3
1Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo NY; SUNY Upstate Medical University Norton College of Medicine, Syracuse NY.
The Journal of Hand Surgery
|August 5, 2023
Summary
Concurrent wrist and thumb surgery significantly increases first ray subsidence. Performing proximal row carpectomy (PRC) with trapeziectomy poses a substantial risk of metacarpal instability.
Area of Science:
- Orthopedic surgery
- Biomechanics
- Hand surgery
Background:
- Concurrent wrist and thumb pathologies often necessitate surgical intervention.
- Proximal row carpectomy (PRC) and trapeziectomy are common procedures for these conditions.
- The biomechanical impact of performing both procedures simultaneously on first ray stability is not well understood.
Purpose of the Study:
- To evaluate the axial stability of the first metacarpal after trapeziectomy and after combined trapeziectomy with PRC.
- To determine the mechanical effects of performing these procedures concurrently on cadaveric specimens.
Main Methods:
- Eleven fresh-frozen cadaveric distal forearm specimens were utilized.
- A material test system applied a 20 N force to simulate lateral pinch.
- Axial displacement (subsidence) of the first metacarpal was measured in native state, after trapeziectomy, and after combined trapeziectomy with PRC.
Main Results:
- Native specimens showed an average subsidence of 5.1 mm.
- Trapeziectomy alone resulted in an average subsidence of 16.2 mm.
- Combined trapeziectomy with PRC led to a significant increase in subsidence, averaging 25.0 mm.
Conclusions:
- Performing proximal row carpectomy (PRC) concurrently with trapeziectomy significantly increases first metacarpal subsidence compared to trapeziectomy alone.
- This combined approach carries a substantial risk of first ray instability.
- Staging these procedures or employing thumb metacarpal suspension/arthrodesis may be a more effective treatment strategy for concurrent basilar thumb and wrist arthritis.
