PRC with Double Interposition Arthroplasty for Failed Partial Wrist Arthrodesis

In patients with lunate fossa and proximal capitate degeneration, or failed scaphoid excision and partial wrist arthrodesis, double allograft interposition arthroplasty may allow patients to maintain wrist motion and improve pain.

Following dorsal exposure of the carpus, a completion proximal row carpectomy is performed. Suture anchors are placed evenly along the perimeter of the distal radius and used to secure a precut sheet of allograft. Additional suture anchors are placed at the proximal aspect of the distal carpal row, securing a second piece of allograft to the proximal capitate and hamate.

We present the case of a female with osteogenesis imperfecta who failed prior partial wrist fusion for treatment of scapholunate advanced collapse. She declined wrist arthrodesis and was not a candidate for total wrist arthroplasty. Proximal row carpectomy with double interposition arthroplasty provided resolution of her pain and preserved her wrist range of motion.

Double interposition arthroplasty may provide reliable pain relief and wrist range of motion for patients with advanced wrist arthritis in whom traditional salvage procedures are contraindicated or have failed. Use of this technique offers benefits that may minimize complications and improve longevity compared with previously described allograft interposition techniques.