Proximal Row Carpectomy for Established Post-Traumatic Radiocarpal Arthritis Following Distal Radius Volar Rim and...

Post-traumatic radiocarpal arthritis can occur as a result of complex wrist injuries. Distal radius volar rim fractures associated with scaphoid fractures can result in progressive cartilage degeneration, pain, loss of motion, and functional impairment. Malunited distal radius volar rim fractures, where optimal stabilization is not done, can lead to radiocarpal incongruity and early post-traumatic radiocarpal arthritis. Proximal row carpectomy (PRC) remains a valuable motion-preserving salvage procedure for selected patients with advanced radiocarpal arthritis.

A 32-year-old male presented 4 months after a motorcycle-related injury with persistent right wrist pain, reduced grip strength, difficulty performing fine motor tasks, and limitations in lifting heavy objects. He had sustained a distal radius volar rim fracture and scaphoid fracture and developed radiocarpal arthritis. Clinical examination demonstrated pain aggravated by wrist motion and reduced grip strength. Arthroscopic evaluation confirmed significant post-traumatic chondral degeneration of the radiocarpal joint. The patient underwent wrist arthroscopy, PRC, posterior interosseous nerve neurectomy, capsular interposition arthroplasty, and radiocapitate K-wire stabilization. He subsequently developed early post-traumatic radiocarpal arthritis due to inadequate fixation of the volar rim fragment.

This case highlights the critical importance of recognizing and adequately fixing the distal radius volar rim (volar lunate facet) fragment during the initial management of wrist trauma. Failure to restore the volar buttress resulted in persistent radiocarpal incongruity and rapid progression to symptomatic post-traumatic radiocarpal arthritis within 4 months in a young patient. It demonstrates the role of PRC as a biomechanically sound salvage option for radiocarpal arthritis secondary to a missed or malunited volar rim fracture.