Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review

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.

Predictors of Outcomes Following Fasciectomy for Dupuytren’s Disease in Diabetic and Non-Diabetic Patients

“…The degree of joint contracture correlates to patient functional status, and grip strength is commonly used in upper extremity outcomes studies, with 80% relative strength often established as a benchmark. [9][10][11] Additionally, all patients were screened for post-operative limited joint mobility (LJM) using the Prayer Sign. This clinical examination was performed by having the patient place his or her hands together with the goal of pressing the palms of the hands and palmar surfaces of the interphalangeal joints together.…”

Surgical Treatments for Scapholunate Advanced Collapse Wrist: Kinematics and Functional Performance

“…In contrast, 4CF has been associated with increased risk of hardware removal and infection. 2 Our findings suggest differences in kinematics and functional performance between these 2 surgical cohorts with the PRC group performing better on kinematic and performance variables. The results must be interpreted with caution owing to several limitations of the study.…”

About systematic reviews

“…However, the general 'complication rate' may be very challenging to evaluate and compare across studies. This challenge is made plain in the reviews by Saltzman et al (2015) and by Huang et al (2015). Indeed, the reporting complications are knowingly handled very differently in different studies, among others depending on the study design and the focus of the investigators.…”

“…The authors must ensure that their methods are reported with adequate clarity and transparency to enable readers to critically judge the available evidence and replicate or update the research. This challenge is illustrated by the article 'Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review' (Saltzman et al, 2015): only one prospective randomized trial could be identified and the selection of studies was extended to include retrospective studies. Although the authors aimed at analysing data in studies in which the pre-operative demographics were not significantly different in the treatment groups, this was not always possible, e.g.…”

“…In this and the past issue of the Journal, a number of systematic reviews are published, illustrating the value of reviews, but also the challenges they have to face (Huang et al, 2015;Saltzman et al, 2015;Stockton et al, 2015;Wang et al, 2015). Meta-analysis of randomized studies is rarely a viable option in hand surgery research, given that randomized trials are infrequent.…”