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Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study.

Richard Chan1, Justine Goursat2, Mathilde Payen3

  • 1Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; Chirurgie de la main et plastique adulte, CHU Charles Nicolle, Rouen, France.

Journal of Plastic Surgery and Hand Surgery
|May 21, 2024
PubMed
Summary

Four-corner arthrodesis (FCA) and proximal row carpal resection (PRC) offer comparable wrist strength, mobility, and function for advanced collapse osteoarthritis. Proximal row carpal resection showed a lower revision rate compared to four-corner arthrodesis.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Wrist Osteoarthritis Treatment

Background:

  • Post-traumatic Scaphoid Non-Union Advanced Collapse (SNAC) and Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis commonly require surgical intervention.
  • Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are established surgical options for these conditions.

Purpose of the Study:

  • To compare the clinical outcomes of FCA and PRC in patients with advanced wrist osteoarthritis.
  • To evaluate differences in mobility, strength, function, and patient satisfaction between the two surgical techniques.

Main Methods:

  • A retrospective cohort study analyzed patients undergoing FCA or PRC between 2009 and 2019.
  • Follow-up assessments included range of motion, grip and pinch strength, functional scores (QuickDash, PRWE), and patient satisfaction.

Main Results:

  • No significant differences were observed between FCA and PRC in terms of wrist mobility, strength, or functional scores.
  • Patient satisfaction scores were similar for both procedures.
  • Re-operation rates were higher in the FCA group (14%) compared to the PRC group (0%).

Conclusions:

  • Both FCA and PRC are reliable surgical techniques for managing post-traumatic SNAC/SLAC wrist arthritis stage II.
  • While functional outcomes are comparable, PRC may have a lower revision rate than FCA.