1
|
Gruisen JAE, Schormans PMJ, Punt IM, Roth AK, van Kuijk SMJ, Poeze M, Hannemann PFW. Patient reported and functional outcome measures after surgical salvage procedures for posttraumatic radiocarpal osteoarthritis - a systematic review. BMC Musculoskelet Disord 2024; 25:453. [PMID: 38849773 PMCID: PMC11157883 DOI: 10.1186/s12891-024-07527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
Collapse
Affiliation(s)
- Jane A E Gruisen
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Philip M J Schormans
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Ilona M Punt
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Klinische Epidemiologie en Medical Technology Assessment, Maastricht University, P.Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Martijn Poeze
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| |
Collapse
|
2
|
Chan R, Goursat J, Payen M, Lalevée M, Guelmi K. Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study. J Plast Surg Hand Surg 2024; 59:77-82. [PMID: 38769788 DOI: 10.2340/jphs.v59.18338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/06/2024] [Indexed: 05/22/2024]
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.
Collapse
Affiliation(s)
- 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.
| | - 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
| |
Collapse
|
3
|
Karatan B, Yamak K. Managing Severe Postburn Wrist Flexion Contracture by Proximal Row Carpectomy and Abdominal Interpolation Flap. Plast Surg (Oakv) 2024; 32:244-252. [PMID: 38681246 PMCID: PMC11046275 DOI: 10.1177/22925503221107213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction: Postburn upper extremity contractures can greatly diminish the quality of life. To successfully manage these contractures and achieve successful functional outcomes, an optimal surgical method should be planned to address all affected tissues on the extremities. Conventional soft tissue transfers after releasing the contracture, such as skin grafts or flaps, may be insufficient. In addition to capsulotomy, tendon release, and lengthening procedures, more aggressive modalities may be indicated. Methods: In this retrospective study, patients who developed wrist flexion deformities due to burn injuries and underwent proximal row carpectomy and abdominal interpolation flaps were included. Results: Between January 2019 and June 2020, 5 patients underwent surgery using this technique. All patients were male, 2 had thermal burns, 2 had electrical burns, and 1 had chemical burns. Preoperatively, all patients had severe flexion deformities ranging from 70° to 85°. There were no postoperative complications, and stable wrists with a good and functional alignment were achieved, although the preoperative and postoperative range of motion differences were limited, where a postoperative range of motions were ranging from 5 to 15 in terms of extension, 15 to 20 in terms of flexion. Preoperative QuickDash scores were between 79.5 and 95.5, postoperative scores ranged from 25 to 36.4. Conclusion Proximal row carpectomy shortens the length of the wrist, resurfaces the wrist joint, and provides a release in tendons and other soft tissues. Together with soft tissue transfer, this technique can be used for severe wrist flexion contractures.
Collapse
Affiliation(s)
- Berrak Karatan
- Plastic Reconstructive and Aesthetic Surgery Department, Izmir Bakircay University Cigli Education and Research Hospital1, Izmir, Turkey
| | - Kamil Yamak
- Orthopedics and Traumatology Department, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| |
Collapse
|
4
|
Yeager KC, Parker KM, Morrell NT. A Case for Acute Proximal Row Carpectomy for Perilunate Injuries. THE IOWA ORTHOPAEDIC JOURNAL 2023; 43:14-19. [PMID: 38213853 PMCID: PMC10777708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Perilunate injuries are complex injuries typically arising from high-energy injuries to the wrist. Standard treatment involves open reduction and internal fixation with ligamentous reconstruction; however, outcomes are fraught with complications including pain, stiffness, and arthrosis. Several case reports have demonstrated the role of proximal row carpectomy as a salvage procedure for complex carpal trauma in the setting of significant cartilage injury or bone loss. The authors believe that proximal row carpectomy may be an appropriate acute treatment in certain patient populations, with functional results similar to those obtained with ligamentous reconstruction. Methods A retrospective review of two cases with perilunate dislocations managed with primary proximal row carpectomy are presented. Results At greater than 1-year follow-up, both patients had stable radiocarpal alignment. Quick-DASH scores were 22.7 and 27.3. Conclusion Primary proximal row carpectomy is a treatment option in the acute setting for perilunate injuries in elderly, lower-demand patients. Functional results are similar to those obtained with ligamentous reconstruction, with a shorter recovery period. Level of Evidence: IV.
Collapse
Affiliation(s)
- Kathryn C. Yeager
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Kate M. Parker
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Nathan T. Morrell
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Hospital, Albuquerque, New Mexico, USA
| |
Collapse
|
5
|
Gvozdenovic R, Schioedt MA, Solgaard L, Vadstrup LS, Soee NH. Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years. J Orthop Surg Res 2023; 18:681. [PMID: 37705034 PMCID: PMC10498579 DOI: 10.1186/s13018-023-04177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023] Open
Abstract
The present study compares the postoperative clinical, radiological, and patient-reported functional results between the surgical procedures Proximal Row Carpectomy and Limited Carpal Fusion, in the treatment of SLAC and SNAC conditions of the wrist. 15 Proximal Row Carpectomy patients and 45 Limited Carpal Fusion patients were included in the study. Postoperative outcomes were assessed and compared for pain at load, range of motion, grip strength, Quick-DASH, and satisfaction. A radiological assessment was performed at the follow-up. The Proximal Row Carpectomy patients had a mean age of 60 years (range 31-77) and a mean follow-up of 42 months. The Limited Carpal Fusion patients had a mean age of 58 years (range 35-76) and a mean follow-up of 41 months. The patients treated with Limited Carpal Fusion performed significantly better regarding pain, radial-ulnar motion, and the Quick-DASH (p = 0.002, p = 0.003, and p = 0.002), respectively. The grip strength difference between the treatment groups was stratified for gender and was found significantly better for men in the LCF-treated patients, but not different for women (p = 0.03, p = 0.26), respectively. Differences in flexion-extension between the groups were insignificant (p = 0.525). A higher conversion rate to total wrist fusion was observed in the patients treated with the Proximal Row Carpectomy. All the Proximal Row Carpectomy patients had osteoarthritis at follow-up, whereas it was seen in 19% of the Limited Carpal Fusion patients. The patient-reported satisfaction was substantially better for the Limited Carpal Fusion patients. In conclusion, among patients treated for SNAC and SLAC wrist conditions, besides the findings of flexion-extension, and grip strength which were found without difference for women the findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy. Further, preferably prospective studies are needed to confirm or reject our findings.Level of evidence: Retrospective, comparative cohort study, level III.
Collapse
Affiliation(s)
- Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark.
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Martina Agerskov Schioedt
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Solgaard
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Soelberg Vadstrup
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Niels Henrik Soee
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| |
Collapse
|
6
|
LoGiudice A, Awan H. Wrist Arthritis and Arthrodesis: Preserving Function, Minimizing Problems. Hand Clin 2023; 39:353-365. [PMID: 37453763 DOI: 10.1016/j.hcl.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
Collapse
Affiliation(s)
- Anthony LoGiudice
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Hisham Awan
- Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
| |
Collapse
|
7
|
Reyniers P, van Beek N, De Schrijver F, Goeminne S, Reyniers P. Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review. HAND SURGERY & REHABILITATION 2023; 42:194-202. [PMID: 37031919 DOI: 10.1016/j.hansur.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.
Collapse
Affiliation(s)
- P Reyniers
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | - N van Beek
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | | - S Goeminne
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | |
Collapse
|
8
|
Loewenstein SN, Regent-Smith A, LoGiudice A, Hoben G, Dellon AL. Ulnar Wrist Denervation: Articular Branching Pattern and Selective Blockade of the Dorsal Branch of the Ulnar Nerve. J Hand Surg Am 2023:S0363-5023(23)00072-2. [PMID: 36966047 DOI: 10.1016/j.jhsa.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 01/16/2023] [Accepted: 02/08/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE Ulnar wrist denervation has been a successful treatment for patients with ulnar-sided wrist pain. The purpose of this study was to characterize the articular branches of the dorsal branch of the ulnar nerve (DBUN) and validate a technique for selective peripheral nerve blockade. METHODS In cadavers, we performed simulated local anesthetic injections using 0.5 mL of 0.5% methylene into the subcutaneous tissue at a point midway between the palpable borders of the pisiform and ulnar styloid. We then dissected the DBUN, characterized its articular branching pattern, and measured staining intensity of the DBUN and the ulnar nerve relative to a standard. RESULTS The DBUN branched from the ulnar nerve 7.0 ± 1.2 cm proximal to the ulnar styloid. Among 17 specimens, the DBUN provided an average of 1.2 (range, 0-2) ulnocarpal branches and 1.0 (range, 0-2) carpometacarpal articular branches. A simulated local anesthetic injection successfully stained 100% of the DBUN articular branches at or proximal to their takeoff. There was no staining of the proper ulnar nerves. In all specimens, the DBUN supplied at least one articular branch. CONCLUSIONS A point midway between the palpable border of the pisiform and ulnar styloid may be an effective location for selectively blocking the DBUN articular afferents. CLINICAL RELEVANCE In this study, we were able to identify a point halfway between the pisiform and ulnar styloid that has the potential to produce a selective peripheral nerve block of the portion of the DBUN that supplies articular fibers to the ulnocarpal joint and the fifth carpometacarpal joint. This technique may prove useful to surgeons treating ulnar-sided wrist pain.
Collapse
Affiliation(s)
- Scott N Loewenstein
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI; Department of Plastic and Hand Surgery, HealthPartners Regions Hospital, Saint Paul, MN; Division of Plastic & Reconstructive Surgery, University of Minnesota, Minneapolis, MN.
| | | | - Anthony LoGiudice
- Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Gwendolyn Hoben
- Department of Plastic Surgery, Medical College of Wisconsin, Wauwatosa, WI
| | - Arnold Lee Dellon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
9
|
Proximal row carpectomy of the wrist in the setting of midcarpal arthritis: Survivorship and associated complications in soft tissue interposition versus capitate resurfacing. CURRENT ORTHOPAEDIC PRACTICE 2023. [DOI: 10.1097/bco.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
|
10
|
Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients. J Hand Surg Am 2023; 48:195.e1-195.e10. [PMID: 34857405 DOI: 10.1016/j.jhsa.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) is a motion-sparing procedure with good patient-reported and clinical outcomes. Although some studies have investigated the risk of conversion to total wrist arthrodesis (TWA) after PRC, additional larger studies evaluating the specific risk factors that lead to failure are required. This study aimed to investigate the patient and procedure factors that are associated with increased risk for conversion to TWA in a large cohort of patients who underwent PRC. METHODS The current procedural technology codes identified patients in a National Veteran's Health database undergoing a PRC over a 26-year period. Risk factors of interest comprised age, posterior interosseous nerve neurectomy, wrist arthritis pattern, bilateral surgery, smoking, comorbidities, and preoperative opioid use. The primary outcome was the rate of conversion to TWA. Cox proportional hazard regression was used to create hazard ratios of selected factors for reoperation. RESULTS There were 1,070 PRCs performed, with a mean follow-up of 79.8 ± 59.6 months. A total of 5.3% (57/1,070) wrists underwent conversion to TWA. Younger age at the time of PRC (<50 years) significantly increased the risk of TWA (hazard ratio, 3.8; 95% confidence interval, 2.2-6.6). With every 1-year increase in age, there was a reduction of 4% (hazard ratio, 0.96; 95% confidence interval: 0.94-0.98) in the hazard of conversion to TWA. No other factors, including concomitant posterior interosseous nerve neurectomy or bilateral PRC, increased the risk of conversion to TWA. CONCLUSIONS Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. Younger patient age increases the risk of conversion to arthrodesis, whereas posterior interosseous nerve neurectomy, bilateral PRCs, and comorbidity status do not appear to have an impact on the risk of arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
|
11
|
Perry AC, Wilkes C, Curran MWT, Ball BJ, Morhart MJ. Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review. J Wrist Surg 2023; 12:86-94. [PMID: 36644731 PMCID: PMC9836777 DOI: 10.1055/s-0042-1751013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.
Collapse
Affiliation(s)
- Alexander C. Perry
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Wilkes
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew W. T. Curran
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Morhart
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
12
|
Teunissen JS, Duraku LS, Feitz R, Zuidam JM, Selles RW, Wouters RM. Routinely-Collected Outcomes of Proximal Row Carpectomy. J Hand Surg Am 2022:S0363-5023(22)00539-1. [PMID: 36372595 DOI: 10.1016/j.jhsa.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe patient-reported pain and function 12 months after proximal row carpectomy (PRC). Secondary outcomes included return to work, grip strength, range of wrist motion, satisfaction with treatment results, and complications. METHODS This cohort study was part of the British Society for Surgery of the Hand Studyathon 2021, using ongoing routinely-collected data of 304 eligible patients who underwent PRC (73% scapholunate advanced collapse, 11% scaphoid nonunion advanced collapse wrist; 11% Kienböck, 5% other indications) from Xpert Clinics, the Netherlands between 2012-2020. The primary outcome was the Patient Rated Wrist/Hand Evaluation total score (range, 0-100, lower scores indicate better performance). RESULTS Of the 304 patients, the primary outcome was available in 217 patients. The total Patient Rated Wrist/Hand Evaluation score improved from 60 (95% confidence interval [CI], 57-63) to 38 (95% CI, 35-41) at 3 months, and 26 (95% CI, 23-29) at 12 months. The pain and function subscales improved by 18 (95% CI, 17-20) and 16 (95% CI, 14-18) points, respectively. At 12 months, 82% had returned to work at a median time of 12 (95% CI, 9-14) weeks following PRC. Grip strength did not improve. Wrist flexion and extension demonstrated a clinically irrelevant decrease. Satisfaction with treatment result was excellent in 27% of patients, good in 42%, fair in 20%, moderate in 6%, and poor in 5%. Complications occurred in 11% of patients, and conversion to wrist arthroplasty occurred in 2 patients. CONCLUSION A clinically relevant improvement in patient-reported pain and function was observed at 3 months after PRC, with continued improvement to 12 months. These data can be used for shared-decision making and expectation management. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Joris S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands.
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reinier Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Mastrantonakis KN, Daskalogiannakis EI, Papadaki HI, Kalinterakis G, Liodakis K, Prevezanos D. Functional Scaphoid Pseudarthrosis. Two Cases with Long-term Follow-up after Closed Wedge Osteotomy of the Distal Radius. J Orthop Case Rep 2022; 12:73-77. [PMID: 36873343 PMCID: PMC9983416 DOI: 10.13107/jocr.2022.v12.i09.3324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/09/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Closed wedge osteotomy of the distal radius represents a treatment option for the advanced scaphoid pseudarthrosis. Few authors have reported good results with many of the cases achieving union of the scaphoid. The aim of this study is to inform about the functional long-term outcome of two patients in whom bone union was not achieved after this procedure. Case Report In this article, we present two patients, one with 5 and one with 40 years of follow-up who were treated with closed wedge osteotomy of the distal radius due to advanced scaphoid nonunion. We evaluated the functional outcome which was excellent and in addition radial translocation of the carpus was found as it was compared the anteroposterior radiographs before surgery and at the end of the follow-up period. Conclusion Closed wedge osteotomy of the radius is an extra articular procedure that can cause radial translocation of the wrist and change its biomechanics, while the functional outcome does not depend on whether fracture healing is achieved.
Collapse
Affiliation(s)
| | | | - Haris I Papadaki
- Department of Orthopedics, General Hospital of Rethymnon, Rethymnon 74100, Greece
| | | | | | - Dionysios Prevezanos
- Department of Orthopedics, General Hospital of Rethymnon, Rethymnon 74100, Greece
| |
Collapse
|
14
|
Surgical management of osteoarthritis of the hand and wrist. J Hand Ther 2022; 35:418-427. [PMID: 35428565 DOI: 10.1016/j.jht.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteoarthritis of the hand and wrist is common; varying disease manifestations and a spectrum of symptoms make it imperative to approach treatment strategies in an individualized fashion. In this review, attention is focused upon site specific diagnoses and indications for various surgical treatment strategies.
Collapse
|
15
|
Chojnowski K, Opiełka M, Piotrowicz M, Sobocki BK, Napora J, Dąbrowski F, Piotrowski M, Mazurek T. Recent Advances in Assessment and Treatment in Kienböck's Disease. J Clin Med 2022; 11:jcm11030664. [PMID: 35160115 PMCID: PMC8836398 DOI: 10.3390/jcm11030664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 12/17/2022] Open
Abstract
Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.
Collapse
|
16
|
Andronic O, Nagy L, Burkhard MD, Casari FA, Karczewski D, Kriechling P, Schweizer A, Jud L. Long-term outcomes of the four-corner fusion of the wrist: A systematic review. World J Orthop 2022; 13:112-121. [PMID: 35096541 PMCID: PMC8771412 DOI: 10.5312/wjo.v13.i1.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/26/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Four-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF.
AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.
METHODS The systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.
RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.
CONCLUSION The 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.
Collapse
Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Marco D Burkhard
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Fabio A Casari
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Daniel Karczewski
- Department of Trauma and Orthopaedics, Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Berlin 10117, Germany
| | - Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Switzerland, Zürich 8008, Switzerland
| |
Collapse
|
17
|
Campbell CC, Neustein TM, Daly CA, Wagner ER. Surgical Treatment of Wrist Arthritis in Young Patients. JBJS Rev 2021; 8:e0078. [PMID: 32149931 DOI: 10.2106/jbjs.rvw.19.00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
Collapse
|
18
|
Zhang Y, Gillis JA, Moran SL. Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. J Hand Surg Eur Vol 2021; 46:50-57. [PMID: 33202162 DOI: 10.1177/1753193420973322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.
Collapse
Affiliation(s)
- Yiyang Zhang
- Division of Orthopedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Jerome TJ, Prabu GR. Proximal row carpectomy for complex perilunate fracture dislocations with migration of proximal scaphoid bone into the forearm. HAND SURGERY & REHABILITATION 2020; 40:299-304. [PMID: 33309983 DOI: 10.1016/j.hansur.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022]
Abstract
Complex perilunate dislocations include scaphoid, triquetrum, radial styloid fractures, and associated ligamentous injuries. The purpose of the study is to assess the role of proximal row carpectomy (PRC) in such complex injuries involving the proximal scaphoid migration and analyze the outcome. We operated on eighteen patients with complex perilunate dislocations and extreme proximal migration of proximal scaphoid by PRC between 2012 and 2018. We analyzed the postoperative radiographs, VAS pain score, range of motion, return to work, Quick DASH and Mayo wrist scores and assessed the overall functional outcome. The average follow-up was 46 months. The mean range of wrist flexion was 65%, extension 70 %, pronation 88%, supination 90%, and grip strength 70% of the opposite side. The median VAS pain score was 0.1 (range, 0-3). Median Quick DASH score was 4.4 (range, 3.3-6.7), and Mayo wrist score 70 (range, 65-75). The age, gender, side of injury, dominant hand, fracture displacement or type, osteochondral fracture of the capitate head, and treatment delay had no significant impact on the functional outcome. The presence of degenerative changes had no significant association with age, grip strength, range of movements, pain, and outcome scores. All patients had good subjective satisfaction with the surgery and functional outcome. PRC is a reliable option for complex perilunate fracture-dislocations with extended proximal migration of the scaphoid proximal pole. The degenerative changes after PRC may progress with time, mostly when done for young patients. Outcomes of salvage procedure in the long-term follow-up need to be taken into account when counselling patients on the treatment of these injuries.
Collapse
Affiliation(s)
- T J Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamil Nadu 620017, India.
| | - G R Prabu
- Department of Orthopedics, KAPV Medical College Hospital, Periyamilaguparai, Colletor's Office Road, Trichy, Tamil Nadu 620001, India
| |
Collapse
|
20
|
Long-term radiological changes and functional outcomes after proximal row carpectomy: Retrospective study with 3 years' minimum follow-up. Orthop Traumatol Surg Res 2020; 106:1589-1595. [PMID: 33289656 DOI: 10.1016/j.otsr.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the radiological changes and determine the clinical and functional outcomes of proximal row carpectomy (PRC) over the long term. HYPOTHESIS Radiological changes after PRC occur in every patient while the clinical and functional outcomes remain stable over time. METHODS This was a retrospective single-center study of patients who underwent PRC between January 2004 and December 2014. A clinical assessment (range of motion, grip strength), functional assessment (Mayo Wrist score and QuickDASH) and radiographic assessment (radiocapitate osteoarthritis, radiocapitate congruency) was done in every patient at the longest follow-up. RESULTS Thirty-one patients were reviewed with a mean follow-up of 97.9 months. The indications for PRC were SLAC (n=10), SNAC (n=5), Kienböck disease (n=9) and other conditions (n=7). The radiocapitate index, which is the radius of curvature of the tip of the capitate divided by the mean radius of curvature of the lunate fossa, went from 0.68 immediately postoperative to 0.74 at the final assessment (p=0.035). The mean flexion/extension arc was 93°. The mean grip strength was 25 kg. The mean QuickDASH was 29 and the mean Mayo Wrist score was 69. Fifteen patients had radiocapitate osteoarthritis. Seven patients (22%) required revision surgery for wrist fusion after a mean of 18.6 months. CONCLUSION Radiological adaptation in the radiocapitate joint after PRC was found in this study. PRC is a reliable solution and yields stable outcomes over time for treating radiocarpal osteoarthritis, except in young adults and manual laborers who had a notable early revision rate. LEVEL OF EVIDENCE IV - retrospective study.
Collapse
|
21
|
Garcia BN, Lu CC, Stephens AR, Kazmers NH, Chen W, Leng J, Li L, Sauer BC, Tyser AR. Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. J Bone Joint Surg Am 2020; 102:1050-1058. [PMID: 32187124 DOI: 10.2106/jbjs.19.00965] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND For stage-II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis, the optimal method of surgical treatment remains unclear. Previous literature has demonstrated similar clinical outcomes between proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA), making the risk of reoperation a focus of particular interest. In the present study, the primary null hypothesis was that there would be no difference in the rate of conversion to total wrist arthrodesis between PRC and FCA. Additionally, we hypothesized that the rate of secondary surgical procedures would be similar between the 2 procedures. METHODS The national Veterans Health Administration Corporate Data Warehouse was utilized to identify 2,449 patients who underwent either PRC or FCA between 1992 and 2016. With use of operative reports to identify the arthritis pattern, only cases of stage-II SLAC/SNAC were included. All complications and subsequent surgical procedures were confirmed by manual chart review. Propensity score analyses with matching weights were utilized to balance the PRC and FCA cohorts. The rates of conversion to wrist arthrodesis and secondary surgical procedures were calculated. RESULTS Of the 1,168 patients with stage-II SLAC/SNAC arthritis, 933 wrists underwent PRC and 257 wrists underwent FCA. Ten-year survival free of total wrist arthrodesis in the matching PRC (251 procedures) and FCA (251 procedures) cohorts was 94.3% (95% confidence interval [CI], 92.3% to 96.3%) and 94.1% (95% CI, 90.8% to 97.4%), respectively. Survival free of a secondary surgical procedure other than wrist arthrodesis was 99.7% (95% CI, 99.3% to 100.0%) for PRC and 83.5% (95% CI, 78.2% to 88.8%) for FCA. CONCLUSIONS PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. In contrast, the rate of secondary surgical procedures following FCA was significantly higher compared with PRC. Given the historically similar clinical outcomes between PRC and FCA, the results of the present study show that PRC may be a preferable treatment for stage-II SLAC/SNAC wrist arthritis. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Brittany N Garcia
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Chao-Chin Lu
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Stephens
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Wei Chen
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jianwei Leng
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian C Sauer
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| |
Collapse
|
22
|
Yoo M, Nelson RE, Illing DA, Martin BI, Tyser AR, Kazmers NH. Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis. JB JS Open Access 2020; 5:e0080. [PMID: 33123669 PMCID: PMC7418915 DOI: 10.2106/jbjs.oa.19.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and
scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform
clinical decision-makers, we conducted a cost-effectiveness analysis
comparing proximal row carpectomy (PRC) and four-corner arthrodesis
(FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs,
and health utilities between PRC and FCA. The model used a 10-year time
horizon and a 1-month cycle length, and it was evaluated from the societal
perspective. Utilities and clinical parameters including transition
probabilities for debridement for infection, removal of implants, conversion
to total wrist arthrodesis, revision FCA, and revision total wrist
arthrodesis were obtained from published literature. Timing of complications
was estimated from the literature. Direct medical costs were derived from
Medicare ambulatory surgical cost data, and indirect costs for missed work
due to surgical procedures and complications were included. The
effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic
sensitivity analysis and 1-way threshold analysis for utilities were
performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and
greater effectiveness). The mean (and standard deviation) for the total cost
and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28,
respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26,
respectively, for FCA. In the probabilistic sensitivity analysis, PRC
dominated FCA in 57% of the 1 million iterations. The cost-effectiveness
acceptability curve indicated that PRC is the most cost-effective strategy
regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic
sensitivity analysis. These results suggest that PRC is the optimal strategy
for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV. See Instructions for Authors for a
complete description of levels of evidence.
Collapse
Affiliation(s)
- Minkyoung Yoo
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah.,VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Damian A Illing
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Brook I Martin
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| |
Collapse
|
23
|
Proximal Row Carpectomy Versus 4-Corner Fusion: Incidence, Conversion to Fusion, and Cost. J Hand Surg Am 2020; 45:427-432. [PMID: 32089379 DOI: 10.1016/j.jhsa.2019.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 10/26/2019] [Accepted: 12/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary objective of this study was to compare incidence, demographic trends, and rates of subsequent fusion between proximal row carpectomy (PRC) and 4-corner fusion (4CF) among patients in the United States. METHODS A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from the years 2005 through 2014 among enrollees in the PearlDiver database. Regional distribution, demographic characteristics, annual incidence, comorbidities, and subsequent wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age- and sex-matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average direct cost. RESULTS Patients undergoing 4CF and PRC did not have statistically significant differences in comorbidities. The incidence of the procedures among all subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,000) from 2005 to 2014. Comparing the matched cohorts, patients who underwent 4CF had a higher rate of subsequent fusion than those who underwent PRC (2.67% vs 1.79%). Readmission rates were not significantly different at 30 or 90 days. Average direct cost was significantly greater for 4CF than for PRC. CONCLUSIONS Both PRC and 4CF have been utilized at increasing rates in the past decade. Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
|
24
|
Hachisuka H, Sunagawa T, Ochi M, Morrison WA. A vascularized medial femoral condyle cortico-periosteal graft for total lunate reconstruction. J Orthop Sci 2020; 25:354-358. [PMID: 28830697 DOI: 10.1016/j.jos.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 07/29/2017] [Accepted: 08/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Hiroki Hachisuka
- Department of Orthopaedic Surgery, National Hospital Organization Kure Medical Center Chu-goku Cancer Center, 3-1 Aoyama-cho, Kure, Hiroshima, 737-0023, Japan.
| | - Toru Sunagawa
- Department of Health Science, School of Medicine, Hiroshima University, Hiroshima, Japan
| | - Mitsuo Ochi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | | |
Collapse
|
25
|
Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis. J Hand Surg Am 2020; 45:85-94.e2. [PMID: 31839367 DOI: 10.1016/j.jhsa.2019.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 08/26/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) are common salvage procedures for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse. This study aimed to assess rates of reoperation and conversion to wrist fusion and to assess the factors associated with reoperation and conversion to wrist fusion for patients treated with PRC and FCA. METHODS A retrospective chart review was performed evaluating 266 adult patients undergoing PRC or FCA at a single institutional system from 2002 to 2016. Demographic data, patient- and injury-specific data, reoperation and conversion rates, and complications were collected. Potential factors associated with reoperation or wrist fusion were evaluated using a bivariate, followed by a multivariable, analysis. RESULTS Reoperation was more commonly performed in FCA (34%) than in PRC (11%) (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.7-6.8) and occurred at a shorter postoperative interval. In a multivariable analysis for reoperation, manual labor was associated with reoperation in patients undergoing FCA (OR, 5.4; 95% CI, 1.5-19.1). In those undergoing PRC, anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was associated with a lower rate of reoperation (OR, 0.18; 95% CI, 0.06-0.57). In a multivariable analysis for conversion to wrist arthrodesis, intraoperative AIN and/or PIN neurectomy (OR, 0.18; 95% CI, 0.06-0.57) was associated with a lower rate of conversion to wrist fusion, and smoking (OR, 4.9; 95% CI, 1.8-13.5) was associated with a higher rate of conversion to wrist fusion. In the subanalysis of patients who underwent PRC, only AIN and/or PIN neurectomy was associated with lower rates of conversion to wrist arthrodesis (OR, 0.15; 95% CI, 0.04-0.56). CONCLUSIONS In our cohort, we observed that AIN and/or PIN neurectomy reduced the risk of reoperation and conversion to wrist arthrodesis after PRC. Smoking increased the odds of conversion to wrist arthrodesis in the combined PRC/FCA cohort; however, it is unclear whether this was due to smoking itself or whether the indications for PRC or FCA were affected, leading to this result. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
Collapse
|
26
|
Schmidt I. Functional Outcomes After Salvage Procedures for Wrist Trauma and Arthritis (Four-Corner Fusion, Proximal Row Carpectomy, Total Wrist Arthroplasty, Total Wrist Fusion, Wrist Denervation): A Review of Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background:
Several salvage procedures for the arthritically destroyed wrist exist. Each of these has advantages as well as disadvantages.
Aims:
The aim of this article is to give practical insights for the clinician on: (1) biomechanical and clinical fundamentals of normal and impaired wrist motion; (2) difficulties in assessment of postoperative outcome between measured motion by the surgeon and self-reported outcome by the patient; (3) indications for each procedure; and (4) differences in functional outcome between partial and complete motion-preserving as well as complete motion-restricting salvage procedures.
Methods:
In trend, Proximal Row Carpectomy (PRC) is slightly superior over four-corner fusion (4CF) in terms of functional outcome, but the methodology-related postoperative motion is decreased for both procedures. Furthermore, PRC is easier to perform, needs lower costs, and has fewer complications than 4CF. Total Wrist Arthroplasty (TWA) has the advantage compared to PRC and 4CF that the preoperative motion values are preserved, but it is limited by decreased load-bearing capacity for the wrist. Total Wrist Fusion (TWF) is associated with a higher load-bearing capacity for the wrist than TWA, but it is limited for carrying out essential activities of daily living. Both PRC and 4CF can be combined primarily by wrist denervation. Wrist denervation alone does not impair the movement of the wrist.
Results and Conclusion:
Salvage procedures for the arthritically destroyed wrist should be detected regarding patients age- and gender-related claims in work and leisure. Not all of them can be successfully re-employed in their original occupations associated with high load-bearing conditions.
Collapse
|
27
|
Tahta M, Aydin Y, Erpala F, Yildiz M, Gunal I, Sener M. No Benefits of Combining Proximal Row Carpectomy With PIN Neurectomy for Wrist Disorders-A Comparative Study With Systematic Review of the Literature. Plast Surg (Oakv) 2019; 27:130-134. [PMID: 31106170 DOI: 10.1177/2292550319826099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Posterior interosseous nerve (PIN) resection in combination with proximal row carpectomy (PRC), is a preferred method in order to obtain rapid recovery. However, the contribution of such combination to results isn't known well. Objectives We performed a comparative study to evaluate the effects of PIN neurectomy for PRC and a systematic review of the literature was performed to identify whether such combination has an advantage. Methods Patients with wrist diseases who underwent PRC were evaluated retrospectively. Patients without PIN neurectomy (group 1, n = 7) and with PIN neurectomy (group 2, n = 8) were compared in respect of mean age, follow-up, gender, Q-DASH, VAS, MAYO wrist scores, flexion-extension/radial-ulnar deviation range of motion at final follow-up. The MEDLINE database was searched for studies published between 2005 and 2015, as the second part of the study. The following keywords were used: "proximal," "row," "carpectomy." Studies, which met the inclusion criteria, were evaluated in terms of such combination. Results There were no significant difference between the groups in regard with age (P = .463), follow-up period (P = .728), the ranges of flexion-extension (P = .431) and radio-ulnar deviation (P = .689), Q-DASH (P = .452), and MAYO scores (P = .728). In the second part of the study, 12 studies met the inclusion criteria and none of them was specifically evaluating such combination. Only one study had specific comments on PRC with PIN neurectomy. Conclusion According to our study (which, to our knowledge, was the first comparative study in the literature), we advocate not to combine PRC with PIN neurectomy for such an approach has no advantage.
Collapse
Affiliation(s)
- Mesut Tahta
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Yener Aydin
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Firat Erpala
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Mehmet Yildiz
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Muhittin Sener
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| |
Collapse
|
28
|
Arianni M, Mathoulin C. Arthroscopic Interposition Tendon Arthroplasty for Stage 2 Scapholunate Advanced Collapse. Arthroscopy 2019; 35:392-402. [PMID: 30612763 DOI: 10.1016/j.arthro.2018.10.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/28/2018] [Accepted: 10/28/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report and analyze the functional outcomes of arthroscopic interposition tendon arthroplasty (AITA) in stage 2 scapholunate advanced collapse (SLAC). METHODS Sixteen patients with stage 2 SLAC who underwent AITA between 2009 and 2014 with a minimum of 24-month follow-up were retrospectively evaluated. Medical records were assessed for preoperative and postoperative range of motions, grip strength, visual analog scale, disabilities of the arm, shoulder, and hand (DASH) score, scapholunate angle, and scaphoid fossa-to-scaphoid space. RESULTS After exclusion of 2 patients, 14 patients were available for this study. At final follow-up, improvements were found for the following variables: extension (preoperative mean, 49.29°; VS postoperative mean, 61.07°; P = .025, 95% confidence interval [CI], 1.74-21.85), radial deviation (preoperative mean, 6.43°; postoperative mean, 17.14°; P < .001, 95% CI, 6.06-15.36), grip strength (preoperative mean, 18.93 kg; postoperative mean, 29.64 kg; P < .001; 95% CI, 6.81-14.61), visual analog scale (preoperative mean, 8.07; postoperative mean, 2.50; P < .001; 95% CI, -6.52 to -4.61), and DASH (preoperative mean, 60.39; postoperative mean, 10.28; P < .001, 95% CI, -43.04 to -57.28), scapholunate angle (preoperative median, 67.50°; postoperative median, 55.00°, P = .002, Z = -2.831), and scaphoid fossa-to-scaphoid space (preoperative median, 0.00 mm; postoperative median, 1.00 mm; P < .001, Z = -3.145). There was no improvement in flexion (preoperative mean, 40.00°; postoperative mean, 50.00°;P = .025; 95% CI, -4.45 to -24.45), ulnar deviation (preoperative median, 25.00°; postoperative median, 30.00°;P = .063, Z = -2.060), or flexion-extension arc (preoperative mean, 89.28°; postoperative mean, 111.07°; P = .067; 95% CI, -1.79 to -45.36) following AITA. Nine of 13 patients were satisfied with the procedure, 3 were moderately satisfied, and 1 was not satisfied. CONCLUSIONS Arthroscopic interposition tendon arthroplasty is an acceptable procedure for stage 2 SLAC. This procedure preserves motion, yields acceptable functional outcome, and reduces pain. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Margareta Arianni
- Orthopaedic Surgery, Department of Surgery, Pasar Minggu General Hospital, Jakarta, Indonesia; Hand Clinic/Orthopaedic Surgery, Ramsay Premier Bintaro Hospital, Tangerang, Indonesia
| | | |
Collapse
|
29
|
Gaspar MP, Pham PP, Pankiw CD, Jacoby SM, Shin EK, Osterman AL, Kane PM. Mid-term outcomes of routine proximal row carpectomy compared with proximal row carpectomy with dorsal capsular interposition arthroplasty for the treatment of late-stage arthropathy of the wrist. Bone Joint J 2018; 100-B:197-204. [PMID: 29437062 DOI: 10.1302/0301-620x.100b2.bjj-2017-0816.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone. PATIENTS AND METHODS A total of 25 arthritic wrists (24 patients) with pre-existing degenerative changes of the proximal capitate and/or the lunate fossa of the radius were treated with PRC + DCI over a ten-year period. This group of patients were matched 1:2 with a group of 50 wrists (48 patients) without degenerative changes in the capitate or lunate fossa that were treated with a routine PRC alone during the same period. The mean age of the patients at the time of surgery was 56.8 years (25 to 81), and the demographics and baseline range of movement of the wrist, grip strength, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and Patient-Rated Wrist Evaluation (PRWE) score were similar in both groups. RESULTS At a mean follow-up of 5.9 years (1.8 to 11.8), significant improvements in mean grip strength, the flexion-extension arc of movement of the wrist, QuickDASH, and PRWE scores were seen in both groups. There was no diifference between the groups for any of the outcomes. One patient in the PRC + DCI group required additional surgery for a deep infection, while two in the PRC group had complications (one wound dehiscence requiring revision closure, one transient radial sensory neuritis). One patient in each group required total arthrodesis of the wrist for progressive degenerative radiocarpal changes. A total of 70 patients (93%) were satisfied with the outcomes. CONCLUSION PRC with DCI is an effective form of treatment for late-stage arthritis of the wrist involving the capitolunate joint, with mid-term outcomes that are similar to those in patients without degenerative changes affecting the capitate or lunate fossa who are treated with a routine PRC alone. Cite this article: Bone Joint J 2018;100-B:197-204.
Collapse
Affiliation(s)
- M P Gaspar
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA and Darden School of Business, University of Virginia, 100 Darden Boulevard, Charlottesville, Virginia 22903, USA
| | - P P Pham
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - C D Pankiw
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - S M Jacoby
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - E K Shin
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - A L Osterman
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| | - P M Kane
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, 834 Chestnut Street, The Franklin Building, Suite G114, Philadelphia, PA 19107, USA
| |
Collapse
|
30
|
Traverso P, Wong A, Wollstein R, Carlson L, Ashmead D, Watson HK. Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist. Hand (N Y) 2017; 12:568-572. [PMID: 29091493 PMCID: PMC5669331 DOI: 10.1177/1558944716681949] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function. METHODS A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification. RESULTS Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction. CONCLUSIONS Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.
Collapse
Affiliation(s)
| | | | - Ronit Wollstein
- Technion–Israel Institute of Technology, Haifa, Israel,University of Pittsburgh Medical School, PA, USA,Ronit Wollstein, Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | | | | | | |
Collapse
|
31
|
Anneberg M, Packer G, Crisco JJ, Wolfe S. Four-Year Outcomes of Midcarpal Hemiarthroplasty for Wrist Arthritis. J Hand Surg Am 2017; 42:894-903. [PMID: 28927881 DOI: 10.1016/j.jhsa.2017.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/02/2017] [Accepted: 07/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review the average 4-year outcomes of a cohort of patients with wrist arthritis, treated by a single surgeon with a novel prosthetic hemiarthroplasty of the midcarpal joint. We hypothesized that midcarpal hemiarthroplasty would improve range of motion and grip strength of patients with wrist arthritis, with a complication profile comparable with that of alternative solutions for wrist arthritis. METHODS We reviewed a series of 20 patients treated with a midcarpal hemiarthroplasty at an average of 4 years following surgery. Patients were evaluated objectively with grip strength, wrist range of motion, serial radiographs, and subjectively surveyed with Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo scores. RESULTS Range of motion increased by a mean 33° in flexion-extension and 10° in radial-ulnar deviation compared with preoperative range of motion. Mean grip strength improved to 20.8 kg from 14.1 kg, and Mayo and DASH scores also significantly improved. Three patients had a manipulation under anesthesia for stiffness. One patient required open reduction internal fixation of an unstable fourth carpometacarpal joint after falling. Two patients were revised to a total wrist arthroplasty and 1 to a wrist fusion. CONCLUSIONS Midcarpal hemiarthroplasty provides improved wrist range of motion, grip strength, and patient-reported outcome scores compared with preoperative values, with a complication profile comparable with that of other surgical options for patients with wrist arthritis. Advantages of midcarpal arthroplasty include retention of the native distal carpal row, preservation of midcarpal motion, as well as the option for conversion to a total wrist arthroplasty should revision be required. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Marie Anneberg
- Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Greg Packer
- Southend University Hospital, NHS Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Joseph J Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Scott Wolfe
- Weill Medical College of Cornell University, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
| |
Collapse
|
32
|
Rahgozar P, Zhong L, Chung KC. A Comparative Analysis of Resource Utilization Between Proximal Row Carpectomy and Partial Wrist Fusion: A Population Study. J Hand Surg Am 2017; 42:773-780. [PMID: 28890330 DOI: 10.1016/j.jhsa.2017.07.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE We conducted a population-level analysis comparing proximal row carpectomy (PRC) and partial wrist arthrodesis (PWA) for treatment of chronic wrist arthritis to (1) characterize national practice patterns, (2) determine the rate of conversion to total wrist arthrodesis (TWA), and (3) calculate the associated direct cost of care. METHODS Using the Truven MarketScan databases from 2009 to 2015, we identified patients 18 years or older with a diagnosis of wrist osteoarthritis who had a PRC or PWA and were followed for 18 months. We used Chi-square analysis and multivariable logistic regression to examine patient characteristics associated with conversion to a TWA. Rates of repeat PWA were also obtained, including the total number of procedures until completion and direct treatment cost. RESULTS Of a total of 3,388 eligible patients, 1,305 had a PRC (39%) and 2,083 had a PWA (61%). In patients 54 years of age or younger, PWA was more commonly performed than PRC (49% vs 38%). The TWA rates were significantly higher for patients of all ages who underwent PWA (19.2%) versus PRC (4.9%). Those undergoing PWA required more total procedures than patients who received a PRC (average, 1.7 vs 1.1) resulting in a greater average direct cost per patient ($10,842 vs $7,171). CONCLUSIONS Conversion rates to a TWA are significantly higher with a PWA (19.2%) than with a PRC (4.9%) and have a greater associated direct cost. This includes younger patients, who in the past were considered better candidates for PWA. Our findings suggest that surgeons may need to reevaluate their indications for PWA and that there may need to be a paradigm shift in the current practice patterns for salvage treatment of wrist arthrosis, more often considering PRC for all age groups. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
Collapse
Affiliation(s)
- Paymon Rahgozar
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI.
| |
Collapse
|
33
|
Peymani A, Foumani M, Dobbe JGG, Strackee SD, Streekstra GJ. Four-dimensional rotational radiographic scanning of the wrist in patients after proximal row carpectomy. J Hand Surg Eur Vol 2017; 42:846-851. [PMID: 28681691 PMCID: PMC5598872 DOI: 10.1177/1753193417718427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We measured cartilage thickness, contact surface area, volume of the capitate and shape of the capitate during motion in the operated and unaffected wrists of 11 patients with a mean follow-up of 7.3 years after proximal row carpectomy. Radiocapitate cartilage thickness in the operated wrists did not differ significantly from radiolunate cartilage thickness in the unaffected wrists. The radiolunate surface area was significantly less than the radiocapitate surface area. The volume of the capitate was significantly increased in the operated wrists. The shape of the capitate changed significantly in two of three orthogonal directions. The combination of remodelling of the capitate, increase in its surface area and intact cartilage thickness could help to explain the clinical success of proximal row carpectomy.
Collapse
Affiliation(s)
- A. Peymani
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands,A. Peymani, Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Room G4-226, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - M. Foumani
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - J. G. G. Dobbe
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - S. D. Strackee
- Department of Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - G. J. Streekstra
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Chedal-Bornu B, Corcella D, Forli A, Moutet F, Bouyer M. Long-term outcomes of proximal row carpectomy: A series of 62 cases. HAND SURGERY & REHABILITATION 2017; 36:355-362. [PMID: 28756188 DOI: 10.1016/j.hansur.2017.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/12/2017] [Accepted: 06/04/2017] [Indexed: 12/21/2022]
Abstract
The aim of this study was to determine and analyze the functional and radiographic outcomes after proximal row carpectomy (PRC). We hypothesized that this surgery could restore wrist mobility and function in case of radiocarpal osteoarthritis or severe carpal trauma. Sixty-two patients who had undergone PRC were included in this study: 44 patients with wrist osteoarthritis (11 SNAC, 24 SLAC, 3 Kienböck's disease, 6 other) and 18 patients with severe carpal trauma. Each patient underwent clinical (pain, range of motion, grip strength, functional scores) and radiographic evaluations. At the latest evaluation after a mean of 11.8 years, 15 patients (24.2%) required revision total wrist arthrodesis surgery in a median of 22 months (range, 6-179) because of disabling pain and lack of strength. The failure was statistically correlated with being young and a manual laborer. The range of motion and strength of the operated wrist were 61.5% and 70%, respectively, compared to the contralateral side. PRC remains a reliable procedure for treating wrist arthritis and severe carpal trauma. However, manual activity and being under 50years of age can lead to an early salvage procedure such as total arthrodesis of the wrist. In this subset of the population, another alternative must be considered.
Collapse
Affiliation(s)
- B Chedal-Bornu
- Service de chirurgie de la main, centre hospitalier universitaire de Grenoble, hôpital A.-Michallon, avenue du Marquis-de-Grésivaudan, CS 10217, 38043 Grenoble cedex 9, France.
| | - D Corcella
- Service de chirurgie de la main, centre hospitalier universitaire de Grenoble, hôpital A.-Michallon, avenue du Marquis-de-Grésivaudan, CS 10217, 38043 Grenoble cedex 9, France
| | - A Forli
- Service de chirurgie de la main, centre hospitalier universitaire de Grenoble, hôpital A.-Michallon, avenue du Marquis-de-Grésivaudan, CS 10217, 38043 Grenoble cedex 9, France
| | - F Moutet
- Service de chirurgie de la main, centre hospitalier universitaire de Grenoble, hôpital A.-Michallon, avenue du Marquis-de-Grésivaudan, CS 10217, 38043 Grenoble cedex 9, France
| | - M Bouyer
- Service de chirurgie de la main, centre hospitalier universitaire de Grenoble, hôpital A.-Michallon, avenue du Marquis-de-Grésivaudan, CS 10217, 38043 Grenoble cedex 9, France
| |
Collapse
|
35
|
Musters L, Ten Broek M, Kraan GA. Case Report: SPECT/CT as the New Diagnostic Tool for Specific Wrist Pathology. ACTA ACUST UNITED AC 2017; 6. [PMID: 29725555 DOI: 10.4172/2167-7921.1000246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction Single photon emission computed tomography has been introduced as a promising new diagnostic tool in orthopaedic pathology since the early 90'. Computed tomography, the combined with SPECT, gives insight in the specific sight of wrist pathology. Literature already supports introduction of SPECT/CT in wrist pathology, but clinical application is lagging. Case Report A 40yr old patient reported first in 2004 with persisting pain after a right distal radius fracture. Several diagnostics and operative interventions were performed, all unsuccessful. Because of the persisting pain a SPECT-CT was performed which showed a cyst in the hamate bone, which was successfully enucleated. The patient was finally pain free at recent follow-up. With a QDash-score of 43 and a PRW (H) E-DLV-score of 58/150. Discussion In this case report, SPECT/CT proved a very sensitive diagnostic tool for specific pathology of the wrist. It offered precise localisation and thereby the clinically suspected diagnosis was confirmed and the patient successfully treated.
Collapse
Affiliation(s)
- Linde Musters
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital Delft, The Netherlands
| | - M Ten Broek
- Department of Nuclear Imaging, Reinier de Graaf Hospital, Delft, The Netherlands
| | - G A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital Delft, The Netherlands
| |
Collapse
|
36
|
Wagner ER, Werthel JD, Elhassan BT, Moran SL. Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger Than Age 45 Years. J Hand Surg Am 2017; 42:428-435. [PMID: 28410937 DOI: 10.1016/j.jhsa.2017.03.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
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.
Collapse
Affiliation(s)
- Eric R Wagner
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Jean-David Werthel
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN
| | - Steven L Moran
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
| |
Collapse
|
37
|
Abstract
Partial wrist fusion is a useful technique for the treatment of such specific carpal disorders as arthritis, Kienböck's disease, midcarpal instability, scaphoid nonunion, etc.Many techniques have been described by removing arthritic joint surfaces and transfering load, using, for bone fixation, K-wires, screws, staples, and more recently dedicated plates.The goal of this procedure is to maximise wrist motion and strength while minimizing or eliminating pain.The purpose of this article is to discuss the most commonly used combination of intercarpal arthrodeses, to clarify the indications for each fusion, to describe the appropriate surgical technique for each fusion, and to provide an overview of results and current concepts. Cite this article: Houvet, P. Intercarpal fusions: indications, treatment options and techniques. EFORT Open Rev 2016;1:45-51. DOI: 10.1302/2058-5241.1.000019.
Collapse
Affiliation(s)
- Patrick Houvet
- Institut Français de Chirurgie de la Main, Paris, France
| |
Collapse
|
38
|
Delclaux S, Israel D, Aprédoaei C, Rongières M, Mansat P. Proximal row carpectomy on manual workers: 17 patients followed for an average of 6 years. HAND SURGERY & REHABILITATION 2016; 35:401-406. [PMID: 27890248 DOI: 10.1016/j.hansur.2016.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 09/18/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022]
Abstract
Proximal row carpectomy (PRC) is indicated for the treatment of SNAC or SLAC wrist with preservation of the midcarpal joint. Our hypothesis was that PRC is not appropriate for treating advanced wrist osteoarthritis in patients who carry out heavy manual work. Twenty-three PRCs were performed on 21 patients, 5 women and 16 men with an average age of 54 years (33-77). All patients performed manual work; 11 of them performed heavy manual work. Etiologies were: SLAC wrist in 14 cases (2 stage III, 11 stage II, and 1 stage I) and SNAC wrist in 9 cases (6 stage IIIB and 3 stage IIB). At an average 75 months' follow-up (24-153), five patients were lost to follow-up. Radiocarpal arthrodesis was performed in one patient 10 years after the PRC. In the 17 remaining patients (18 wrists), pain (VAS) averaged 2.2, with residual pain of 5. Flexion-extension range was similar to preoperative levels (67% of contralateral wrist). Wrist strength was decreased by 34% compared to preoperative. The QuickDASH score averaged 26 points and the PRWE 20 points. Radiocapitate distance decreased by 0.3mm on average with joint line narrowing in 6 patients. The carpal translation index was 0.33mm, which was unchanged relative to preoperative values. Three patients had work-related limitations that required retraining and one patient had to be reassigned. PRC preserved the preoperative range of motion and reduced pain levels. However, significant loss of strength was observed, resulting in 23% of manual workers needing retraining or reassignment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- S Delclaux
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - D Israel
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - C Aprédoaei
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - M Rongières
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - P Mansat
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| |
Collapse
|
39
|
An Unusual and Complicated Course of a Giant Cell Tumor of the Capitate Bone. Case Rep Orthop 2016; 2016:3705808. [PMID: 27847665 PMCID: PMC5099473 DOI: 10.1155/2016/3705808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/09/2016] [Accepted: 10/09/2016] [Indexed: 12/21/2022] Open
Abstract
A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometacarpal (CMC III) joint were carried out. Third, due to a secondary midcarpal osteoarthritis and a secondary scaphoid nonunion, the CMC III joint fusion plate was removed and the midcarpal joint completely excised. Fourth, in the absence of recurrence of GCT, a four-corner fusion (4CF) with a corticocancellous iliac crest bone graft and complete excision of the scaphoid bone had to be performed. Fifth, a total wrist arthroplasty (TWA) was performed due to hardware failure of 4CF with migration of a headless compression screw into radiocarpal joint which led to erosion of articular surface of the distal radius. At the 3-year follow-up that includes a 1-year follow-up after TWA, there was no recurrence of GCT, and the TWA was not failed. The patient reported that she would have the motion-preserving TWA again.
Collapse
|
40
|
Wagner ER, Bravo D, Elhassan B, Moran SL. Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients. J Hand Surg Eur Vol 2016; 41:484-91. [PMID: 26228698 DOI: 10.1177/1753193415597096] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/09/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We conducted a review of 144 consecutive patients who underwent proximal row carpectomy from 1967 to 2010 for the diagnosis of wrist arthritis. At a mean follow-up of 13.4 years, patients experienced good pain relief with preservation (but not improvement) of wrist motion. A total of 17 patients (12%) required revision surgery at an average of 44.6 months. Improved pain, function, and survival outcomes were seen in those who underwent proximal row carpectomy after the age of 40, had a preoperative diagnosis of Kienbock's disease, who underwent a concomitant neurectomy procedure, patients who were non-labourers, and patients who underwent surgery after 1990. Although 45% of patients developed moderate to severe radiocapitate arthrosis postoperatively, these findings did not correlate with clinical outcomes or risk of revision surgery. Patients with type II lunate and type II and III capitate shapes had higher rates of postoperative radiocapitate arthrosis. LEVEL OF EVIDENCE III, Prognostic.
Collapse
Affiliation(s)
- E R Wagner
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - D Bravo
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - B Elhassan
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - S L Moran
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA Mayo Clinic, Division of Plastic and Reconstructive Surgery, Rochester, MN, USA
| |
Collapse
|
41
|
Mandarano-Filho LG, Campioto DS, Bezuti MT, Mazzer N, Barbieri CH. Functional outcomes of proximal row carpectomy: 2-year follow-up. ACTA ORTOPEDICA BRASILEIRA 2015; 23:311-4. [PMID: 27057144 PMCID: PMC4775508 DOI: 10.1590/1413-785220152306150054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis METHODS : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique RESULTS : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patients CONCLUSION : Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.
Collapse
|
42
|
Abstract
BACKGROUND With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient. METHODS We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock's disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013. RESULTS Twelve patients were included with a mean age of 41.6 years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1 months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20-110°). The average ulnar deviation was 9° (range 5-15°), and the average radial deviation was 13° (range 5-25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05). CONCLUSIONS Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease.
Collapse
Affiliation(s)
- Matthew L. Iorio
- Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA USA
| | - Colin D. Kennedy
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
| | - Jerry I. Huang
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
| |
Collapse
|
43
|
Abstract
Proximal row carpectomy (PRC) has earned a respected place in the hand surgeon's armamentarium. Prerequisites for the standard PRC are good cartilage on the proximal pole of capitate and in the lunate fossa of radius. If there is cartilage damage on the proximal pole of capitate, the modification of Salomon and Eaton is a reasonable alternative to the standard PRC. The most important surgical step is preservation of the radioscaphocapitate ligament. Good long-term results can be achieved, and with careful patient selection the operation can be done successfully in people who use their hands for heavy work.
Collapse
|
44
|
Saltzman BM, Frank JM, Slikker W, Fernandez JJ, Cohen MS, Wysocki RW. Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. J Hand Surg Eur Vol 2015; 40:450-7. [PMID: 25294736 DOI: 10.1177/1753193414554359] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023]
Abstract
We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I-III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate.
Collapse
Affiliation(s)
- B M Saltzman
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - J M Frank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - W Slikker
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - J J Fernandez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - M S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - R W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
45
|
Joint preservation of the wrist using articulated distraction arthroplasty: a case report of a novel technique. Case Rep Orthop 2015; 2015:812807. [PMID: 25767728 PMCID: PMC4342074 DOI: 10.1155/2015/812807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/04/2015] [Indexed: 11/17/2022] Open
Abstract
Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative.
Collapse
|
46
|
Russchen M, Kachooei AR, Teunis T, Ring D. Acute Proximal Row Carpectomy after Complex Carpal Fracture Dislocation. J Hand Microsurg 2014; 7:212-5. [PMID: 26078546 DOI: 10.1007/s12593-014-0162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022] Open
Abstract
Acute proximal row carpectomy is an uncommon definitive treatment for perilunate fracture dislocations. In this report, we present five patients who had acute proximal row carpectomy (PRC) to treat perilunate fracture-dislocations. All patients were men between ages 31 and 87. The indication for PRC was lunate fracture in two patients, concomitant displaced scaphoid fracture and scapholunate ligament injury in two patients, and perilunate fracture-dislocation with preexisting articular damage from long-standing gout in one patient. At the final follow-up ranged from 4.5 month to 7.5 years, four patients had no pain and one patient was lost to follow-up. One patient had a concomitant PRC and a bridging plate that was never removed. The remaining three patients gained satisfactory range of motion. Our observation reveals that acute proximal row carpectomy is an option for some patients with complex carpal fracture dislocations, particularly those with fracture of the lunate, concomitant scaphoid fracture and scapholunate ligament injury, or preexisting wrist arthritis.
Collapse
Affiliation(s)
- Marjolein Russchen
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Suite 2100, Boston, MA 02114 USA
| | - Amir Reza Kachooei
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Suite 2100, Boston, MA 02114 USA
| | - Teun Teunis
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Suite 2100, Boston, MA 02114 USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, 55 Fruit Street, Suite 2100, Boston, MA 02114 USA
| |
Collapse
|
47
|
Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39:2020-6. [PMID: 25156088 DOI: 10.1016/j.jhsa.2014.06.139] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injury) and chronic (> 6 wk) injuries, between complete and partial tears, and among surgical techniques; identify risk factors for surgical failure; and compare ligament reconstruction with repair with or without capsulodesis in the chronic period. METHODS We performed a retrospective chart review of 82 primary scapholunate interosseous ligament surgeries, with median follow-up of 150 days. A total of 27 patients underwent surgery in the acute period and 50 in the chronic period. (In 5 patients we were unable to determine acuity or chronicity of injury.) In the chronic period, 16 patients underwent repair with or without capsulodesis, 27 underwent ligament reconstruction, and 7 underwent other procedures. RESULTS Surgical intervention in the acute setting involved more complex injuries, most commonly used direct repair, and produced a significantly lower failure rate than chronic intervention. In the chronic setting, the most common technique was ligament reconstruction, which produced superior radiographic outcomes compared with repair with or without capsulodesis. Isolated scapholunate interosseous ligament injuries undergoing chronic surgical intervention composed the majority of failures. Workers' compensation status and chronic intervention were significant risk factors for failure. CONCLUSIONS For chronic injuries, ligament reconstruction produced better radiographic outcomes than repair with or without capsulodesis. Acute intervention (within 6 wk) was preferable to chronic intervention for scapholunate interosseous ligament injuries, and a substantial number of isolated injuries failed to receive treatment in the acute period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
Affiliation(s)
- Eric M Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Matthew D Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Julie E Adams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
| |
Collapse
|
48
|
Pauchard N, Lecoanet-Strugarek C, Segret J, De Gasperi M, Dap F, Dautel G. Dorsal locking plates versus staples in four-corner fusion: a comparative clinical and radiological study. Orthop Traumatol Surg Res 2014; 100:593-7. [PMID: 25155202 DOI: 10.1016/j.otsr.2014.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/06/2014] [Accepted: 05/13/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Four-corner fusion was described in 1984 by HK Watson for the treatment of SLAC wrist. This intervention has undergone few changes since that description, but the debate on the fixation method is still not resolved. HYPOTHESIS Dorsal locking plates provide better stability, short immobilization and a quicker return to daily activities than traditional fixation methods such as staples. MATERIALS AND METHODS Thirty-one fusions using the Medartis Aptus Four-Corner Fusion(®) plate at a mean 13.1 months' follow-up and 35 using staples at a mean 80.4 months' follow-up were reviewed in a clinical and radiographic retrospective comparative study. RESULTS Results were comparable between the two groups in terms of range of motion (flexion-extension arc of 67.3° for plates and 60.6° for staples), force (29.6 and 28 kg.F), pain and disability (PRWE 34.8/150 and 40.9; QuickDASH 19.83/100 and 30). Mean time off work was significantly shorter in the plate group (4.5 vs. 7.9 months). There were no non-unions in the plate group, versus 2 in the staples group. Dorsal impingement implicating hardware was also less frequent in the plate group (2 vs. 11). DISCUSSION The dorsal locking plate did not improve final results in four-corner fusion in terms of range of motion, force, pain or function compared to staples. However, it provided stable fixation, allowing a shorter immobilization and a quicker return to work. Although the initial cost is higher, it could allow significant savings on postoperative costs, shifting the technical debate into the field of public health. LEVEL OF EVIDENCE Level IV, retrospective study.
Collapse
Affiliation(s)
- N Pauchard
- Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France.
| | - C Lecoanet-Strugarek
- Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France
| | - J Segret
- SOS Mains, Orléans-Val-de-Loire, France
| | - M De Gasperi
- DIM, Centre Chirurgical Émile-Gallé, Nancy, France
| | - F Dap
- Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France
| | - G Dautel
- Service de Chirurgie Plastique et Reconstructrice de l'Appareil Locomoteur, Chirurgie de la Main, Centre Chirurgical Émile-Gallé, Université de Lorraine, CHU Nancy, Nancy, France
| |
Collapse
|
49
|
|
50
|
Abstract
The scaphoid is stabilized by the scapholunate ligament (directly) and lunotriquetral ligament (indirectly). Disruption of either of these ligaments leads to a pattern of instability that, left untreated, leads to altered mechanics of the wrist and ultimately debilitating arthritis and collapse. Although arthroscopy remains the gold standard for diagnosis of these injuries, plain films and advanced imaging are useful adjuncts. In the acute setting, conservative treatment may be attempted, but recalcitrant cases require surgical stabilization. Salvage procedures are also available for those patients who fail initial stabilization or present with late degeneration.
Collapse
Affiliation(s)
- Nicholas Caggiano
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPH-2, Bethlehem, PA 18015, USA
| | | |
Collapse
|