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Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion.
J Hand Surg Am. 2014 Dec; 39(12):2424-33.JH

Abstract

PURPOSE

To investigate the effect of 4-corner fusion (4CF) or proximal row carpectomy (PRC) on wrist motion, strength, and outcome for 2 different cohorts from 2 separate institutions performing either 4CF or PRC for stage 2/3 scaphoid nonunion advanced collapse and scapholunate advanced collapse.

METHODS

The researchers assessed 46 subjects (24 4CF and 22 PRC), mean age 54 years, with a flexible electrogoniometer to measure maximum wrist motion and circumduction and compare it with the nonsurgical wrist. We analyzed the shape, size, rate, and smoothness of the circumduction curves. We assessed the maximum grip and sustainability of grip for 60 seconds using a digital grip analyzer. Patient evaluation measure and Michigan Hand Questionnaires measured patient-reported outcomes.

RESULTS

Flexion-extension in the surgically treated wrist was 50% of the nonsurgical side after a 4CF and 65% after a PRC. The radioulnar deviation component in circumduction of the surgically treated wrist was similar but markedly decreased after either procedure. The mean area of circumduction of the surgically treated wrist was similar after a PRC and a 4CF but was 30% of the nonsurgical wrist. The center of the circumduction ellipse after a PRC was closer than after a 4CF to the opposite wrist. The orientation of the plane of circumduction was 22° to the vertical flexion-extension plane after a PRC. After a 4CF, the plane was more vertical (9°). The peak grip strength and the area under the force time curve was 80% of the nonsurgical side after a PRC and 60% after a 4CF. The Michigan Hand Questionnaire result was 90% of the score for the nonsurgical hand after a PRC and 75% of score for the nonsurgical hand after a 4CF.

CONCLUSIONS

The PRC provided improved flexion-extension with a circumduction curve concentric with the nonsurgical wrist. The 4CF limited extension and ulnar deviation more than did a PRC.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands. Electronic address: hpsinghjk@gmail.com.

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.

Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.

MeSH

Carpal BonesCross-Sectional StudiesFemaleHand StrengthHumansLunate BoneMaleMiddle AgedOsteoarthritisOsteotomyRange of Motion, ArticularScaphoid BoneSurveys and QuestionnairesTreatment OutcomeWrist Joint

Pub Type(s)

Journal Article

Multicenter Study

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25443170

Citation

Singh, Harvinder P., et al. "Dynamic Assessment of Wrist After Proximal Row Carpectomy and 4-corner Fusion." The Journal of Hand Surgery, vol. 39, no. 12, 2014, pp. 2424-33.

Singh HP, Brinkhorst ME, Dias JJ, et al. Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. J Hand Surg Am. 2014;39(12):2424-33.

Singh, H. P., Brinkhorst, M. E., Dias, J. J., Moojen, T., Hovius, S., & Bhowal, B. (2014). Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. The Journal of Hand Surgery, 39(12), 2424-33. https://doi.org/10.1016/j.jhsa.2014.09.005

Singh HP, et al. Dynamic Assessment of Wrist After Proximal Row Carpectomy and 4-corner Fusion. J Hand Surg Am. 2014;39(12):2424-33. PubMed PMID: 25443170.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion. AU - Singh,Harvinder P, AU - Brinkhorst,Michelle E, AU - Dias,Joseph J, AU - Moojen,Thybout, AU - Hovius,Steven, AU - Bhowal,Bhaskar, Y1 - 2014/10/14/ PY - 2014/2/27/received PY - 2014/9/3/revised PY - 2014/9/4/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2016/1/28/medline KW - 4-corner fusion KW - Proximal row carpectomy KW - arthrodesis KW - range of motion SP - 2424 EP - 33 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 39 IS - 12 N2 - PURPOSE: To investigate the effect of 4-corner fusion (4CF) or proximal row carpectomy (PRC) on wrist motion, strength, and outcome for 2 different cohorts from 2 separate institutions performing either 4CF or PRC for stage 2/3 scaphoid nonunion advanced collapse and scapholunate advanced collapse. METHODS: The researchers assessed 46 subjects (24 4CF and 22 PRC), mean age 54 years, with a flexible electrogoniometer to measure maximum wrist motion and circumduction and compare it with the nonsurgical wrist. We analyzed the shape, size, rate, and smoothness of the circumduction curves. We assessed the maximum grip and sustainability of grip for 60 seconds using a digital grip analyzer. Patient evaluation measure and Michigan Hand Questionnaires measured patient-reported outcomes. RESULTS: Flexion-extension in the surgically treated wrist was 50% of the nonsurgical side after a 4CF and 65% after a PRC. The radioulnar deviation component in circumduction of the surgically treated wrist was similar but markedly decreased after either procedure. The mean area of circumduction of the surgically treated wrist was similar after a PRC and a 4CF but was 30% of the nonsurgical wrist. The center of the circumduction ellipse after a PRC was closer than after a 4CF to the opposite wrist. The orientation of the plane of circumduction was 22° to the vertical flexion-extension plane after a PRC. After a 4CF, the plane was more vertical (9°). The peak grip strength and the area under the force time curve was 80% of the nonsurgical side after a PRC and 60% after a 4CF. The Michigan Hand Questionnaire result was 90% of the score for the nonsurgical hand after a PRC and 75% of score for the nonsurgical hand after a 4CF. CONCLUSIONS: The PRC provided improved flexion-extension with a circumduction curve concentric with the nonsurgical wrist. The 4CF limited extension and ulnar deviation more than did a PRC. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/25443170/Dynamic_assessment_of_wrist_after_proximal_row_carpectomy_and_4_corner_fusion_ DB - PRIME DP - Unbound Medicine ER -