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Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years.
J Hand Surg Am. 2017 Jun; 42(6):428-435.JH

Abstract

PURPOSE

To examine the long-term outcome of patients aged less than 45 years who underwent either proximal row carpectomy (PRC) or 4-corner arthrodesis (4CA) for wrist arthritis.

METHODS

We reviewed a retrospective cohort of 89 patients aged less than 45 years who underwent either 4CA (n = 51) or PRC (n = 38) for wrist arthritis. Mean follow-up was 11 years in the 4CA group and 18 years in the PRC group.

RESULTS

Overall, there were no differences between groups in the need for revision surgery. Complications included 6 nonunions in the 4CA group (12%), 1 infection in each group, and 11 patients who experienced radiocarpal impingement (8 4CA and 3 PRC). There was no difference in the number of patients reporting moderate or severe pain between the PRC and 4CA groups. Mean flexion-extension arc was 54° after 4CA, compared with 73° after PRC. Patients who underwent 4CA had slightly improved grip strength (65% of the opposite side) compared with those who had PRC (54%). Mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 32 versus 19 (PRC vs 4CA) and patient-rated wrist evaluation scores were 27 versus 28 (PRC vs 4CA). Comparing radiographic arthritis, the 10-year outcome, free of moderate/severe arthritis for the PRC and 4CA groups, was 70% and 71%, respectively.

CONCLUSIONS

Both PRC and 4CA represent a good surgical option for young patients with wrist arthritis, with similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of arthrodesis. Proximal row carpectomy has improved motion and fewer complications.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Wagner ER
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Werthel JD
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Elhassan BT
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
Moran SL
Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN. Electronic address: moran.steven@mayo.edu.

MeSH

AdolescentAdultAge FactorsArthritisArthrodesisCarpal BonesCohort StudiesHand StrengthHumansMiddle AgedRange of Motion, ArticularTreatment OutcomeWrist JointYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28410937

Citation

Wagner, Eric R., et al. "Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years." The Journal of Hand Surgery, vol. 42, no. 6, 2017, pp. 428-435.
Wagner ER, Werthel JD, Elhassan BT, et al. Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years. J Hand Surg Am. 2017;42(6):428-435.
Wagner, E. R., Werthel, J. D., Elhassan, B. T., & Moran, S. L. (2017). Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years. The Journal of Hand Surgery, 42(6), 428-435. https://doi.org/10.1016/j.jhsa.2017.03.015
Wagner ER, et al. Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years. J Hand Surg Am. 2017;42(6):428-435. PubMed PMID: 28410937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years. AU - Wagner,Eric R, AU - Werthel,Jean-David, AU - Elhassan,Bassem T, AU - Moran,Steven L, Y1 - 2017/04/12/ PY - 2017/3/6/received PY - 2017/3/6/revised PY - 2017/3/9/accepted PY - 2017/4/16/pubmed PY - 2018/4/10/medline PY - 2017/4/16/entrez KW - Carpectomy KW - arthrodesis KW - corner KW - proximal KW - row KW - young SP - 428 EP - 435 JF - The Journal of hand surgery JO - J Hand Surg Am VL - 42 IS - 6 N2 - PURPOSE: To examine the long-term outcome of patients aged less than 45 years who underwent either proximal row carpectomy (PRC) or 4-corner arthrodesis (4CA) for wrist arthritis. METHODS: We reviewed a retrospective cohort of 89 patients aged less than 45 years who underwent either 4CA (n = 51) or PRC (n = 38) for wrist arthritis. Mean follow-up was 11 years in the 4CA group and 18 years in the PRC group. RESULTS: Overall, there were no differences between groups in the need for revision surgery. Complications included 6 nonunions in the 4CA group (12%), 1 infection in each group, and 11 patients who experienced radiocarpal impingement (8 4CA and 3 PRC). There was no difference in the number of patients reporting moderate or severe pain between the PRC and 4CA groups. Mean flexion-extension arc was 54° after 4CA, compared with 73° after PRC. Patients who underwent 4CA had slightly improved grip strength (65% of the opposite side) compared with those who had PRC (54%). Mean postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores were 32 versus 19 (PRC vs 4CA) and patient-rated wrist evaluation scores were 27 versus 28 (PRC vs 4CA). Comparing radiographic arthritis, the 10-year outcome, free of moderate/severe arthritis for the PRC and 4CA groups, was 70% and 71%, respectively. CONCLUSIONS: Both PRC and 4CA represent a good surgical option for young patients with wrist arthritis, with similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of arthrodesis. Proximal row carpectomy has improved motion and fewer complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. SN - 1531-6564 UR - https://www.unboundmedicine.com/medline/citation/28410937/Proximal_Row_Carpectomy_and_4_Corner_Arthrodesis_in_Patients_Younger_Than_Age 45_Years_ DB - PRIME DP - Unbound Medicine ER -