Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study

Richard Chan; Justine Goursat; Mathilde Payen; Matthieu Lalevée; Kamel Guelmi

doi:10.2340/jphs.v59.18338

Authors

Richard Chan Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; Chirurgie de la main et plastique adulte, CHU Charles Nicolle, Rouen, France
Justine Goursat Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France
Mathilde Payen Chirurgie Orthopédique Pédiatrique, CHU Charles Nicolle, Rouen, France https://orcid.org/0000-0002-5523-3309
Matthieu Lalevée Chirurgie Orthopédique Adulte, CHU Charles Nicolle, Rouen, France; CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, Université de Rouen, Mont-Saint-Aignan, France
Kamel Guelmi Chirurgie Orthopédique Adulte, GHH Monod, Montivilliers, France

DOI:

https://doi.org/10.2340/jphs.v59.18338

Keywords:

Hand surgery, wrist, four bones arthrodesis, proximal row carpectomy, Scaphoid Non Union Advanced Collapse, Scapho-Lunate Advanced Collapse

Abstract

Background: Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures.

Methods: This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores.

Results: Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12–132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group.

Conclusion: This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.

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