Tags

Type your tag names separated by a space and hit enter

Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II.
J Plast Reconstr Aesthet Surg. 2008 Oct; 61(10):1210-8.JP

Abstract

BACKGROUND

Traumatic instability of the proximal carpal row is based either on a scaphoid fracture or a scapholunate dissociation. Long-standing scaphoid nonunion or scapholunate ligament insufficiency may lead to a carpal collapse and subsequent arthrosis. Controversy exists regarding the appropriate salvage procedure for patients with scapholunate advanced collapse (SLAC)- or scaphoid nonunion advanced collapse (SNAC)-wrist in stage II. Proximal row carpectomy (PRC) and midcarpal arthrodesis (MCA) are two commonly used options. The purpose of this retrospective study was to evaluate the functional outcome and pain relief in SNAC-SLAC-wrist stage II after MCA, compared to PRC in a long term follow up.

METHODS

In the MCA group 17 patients, nine SLAC- and eight SNAC-wrists, with an average age of 47 years at surgery and a mean follow up of 42 months were examined. The PRC group consisted of 30 patients, seven SLAC- and 23 SNAC-wrists, with an average age of 39 years at surgery and a mean follow up of 27 months. Active range of motion (AROM) was verified with a goniometer, grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) under resting and stress conditions. Patients' upper extremity disability was measured with the DASH questionnaire. Radiographic evaluation was carried out by conventional X-ray to verify bony consolidation.

RESULTS

Mean values of postoperative AROM in extension/flexion was 61 degrees in MCA, and 75 degrees in PRC patients; radial/ulnar deviation was 32 degrees and 33 degrees, respectively. Mean DASH-score was 21 in the MCA and 25 in the PRC group. Pain relief was 54% in MCA and 77% in PRC during resting conditions and 22% and 42% during stress conditions. Static grip strength was significantly higher following MCA than PRC (72% to 50%). Among both the MCA and PRC groups three patients required further treatment with total arthrodesis due to persisting pain or absence of bony consolidation.

CONCLUSION

Our data demonstrate that PRC is more favourable for patients who require less grip strength at work. For patients carrying out heavy manual work we recommend MCA due to the significantly better grip strength postoperatively.

Authors+Show Affiliations

Department of ENT and Plastic Surgery, University of Leipzig, Liebigstr.10-14, 04103 Leipzig, Germany. andreas.dacho@medizin.uni-leipzig.deNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17951122

Citation

Dacho, Andreas K., et al. "Comparison of Proximal Row Carpectomy and Midcarpal Arthrodesis for the Treatment of Scaphoid Nonunion Advanced Collapse (SNAC-wrist) and Scapholunate Advanced Collapse (SLAC-wrist) in Stage II." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, vol. 61, no. 10, 2008, pp. 1210-8.
Dacho AK, Baumeister S, Germann G, et al. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg. 2008;61(10):1210-8.
Dacho, A. K., Baumeister, S., Germann, G., & Sauerbier, M. (2008). Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 61(10), 1210-8.
Dacho AK, et al. Comparison of Proximal Row Carpectomy and Midcarpal Arthrodesis for the Treatment of Scaphoid Nonunion Advanced Collapse (SNAC-wrist) and Scapholunate Advanced Collapse (SLAC-wrist) in Stage II. J Plast Reconstr Aesthet Surg. 2008;61(10):1210-8. PubMed PMID: 17951122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. AU - Dacho,Andreas K, AU - Baumeister,Steffen, AU - Germann,Guenter, AU - Sauerbier,Michael, Y1 - 2007/10/22/ PY - 2006/10/20/received PY - 2007/02/11/revised PY - 2007/08/21/accepted PY - 2007/10/24/pubmed PY - 2008/10/28/medline PY - 2007/10/24/entrez SP - 1210 EP - 8 JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg VL - 61 IS - 10 N2 - BACKGROUND: Traumatic instability of the proximal carpal row is based either on a scaphoid fracture or a scapholunate dissociation. Long-standing scaphoid nonunion or scapholunate ligament insufficiency may lead to a carpal collapse and subsequent arthrosis. Controversy exists regarding the appropriate salvage procedure for patients with scapholunate advanced collapse (SLAC)- or scaphoid nonunion advanced collapse (SNAC)-wrist in stage II. Proximal row carpectomy (PRC) and midcarpal arthrodesis (MCA) are two commonly used options. The purpose of this retrospective study was to evaluate the functional outcome and pain relief in SNAC-SLAC-wrist stage II after MCA, compared to PRC in a long term follow up. METHODS: In the MCA group 17 patients, nine SLAC- and eight SNAC-wrists, with an average age of 47 years at surgery and a mean follow up of 42 months were examined. The PRC group consisted of 30 patients, seven SLAC- and 23 SNAC-wrists, with an average age of 39 years at surgery and a mean follow up of 27 months. Active range of motion (AROM) was verified with a goniometer, grip strength was measured with a JAMAR-Dynamometer II. Pain was evaluated by a visual analogue scale from zero to 100 (VAS 0-100) under resting and stress conditions. Patients' upper extremity disability was measured with the DASH questionnaire. Radiographic evaluation was carried out by conventional X-ray to verify bony consolidation. RESULTS: Mean values of postoperative AROM in extension/flexion was 61 degrees in MCA, and 75 degrees in PRC patients; radial/ulnar deviation was 32 degrees and 33 degrees, respectively. Mean DASH-score was 21 in the MCA and 25 in the PRC group. Pain relief was 54% in MCA and 77% in PRC during resting conditions and 22% and 42% during stress conditions. Static grip strength was significantly higher following MCA than PRC (72% to 50%). Among both the MCA and PRC groups three patients required further treatment with total arthrodesis due to persisting pain or absence of bony consolidation. CONCLUSION: Our data demonstrate that PRC is more favourable for patients who require less grip strength at work. For patients carrying out heavy manual work we recommend MCA due to the significantly better grip strength postoperatively. SN - 1878-0539 UR - https://www.unboundmedicine.com/medline/citation/17951122/Comparison_of_proximal_row_carpectomy_and_midcarpal_arthrodesis_for_the_treatment_of_scaphoid_nonunion_advanced_collapse__SNAC_wrist__and_scapholunate_advanced_collapse__SLAC_wrist__in_stage_II_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(07)00437-8 DB - PRIME DP - Unbound Medicine ER -