Hand Replantation with Proximal Row Carpectomy

Abstract

The purpose of this study is to present our operative technique and postoperative results of the hand replantation with proximal row carpectomy in cases of complete amputation at the level of wrist joint. From May 2003 to April 2005, five patients suffered from complete amputation of the hand due to industrial trauma. Amputation level was radiocarpal joint in three cases and midcarpal joint in two cases. Three cases represented guillotine type and two cases with local crush type injuries. All were men and the mean age was 26.6 years. The mean follow-up period was 26.8 months. At the time of replantation, the wrist joint was stabilized with transarticular fixation using three to four Kirschner's wires after performing proximal row carpectomy. Postoperatively, functional results such as muscle strength, range of motion of the wrist and fingers, and sensory recovery were assessed according to Chen's criteria. Joint width and arthritic changes of the radiocapitate joint were evaluated with radiologic tools. According to Chen's criteria, the overall results in five cases were classified as grade II. Intrinsic muscle power of hands was found to be grade 4. The mean grip and pinch powers were 41% and 45%, respectively, compared to contralateral hand. The mean arc of flexion-extension of wrist was 53°. Total mean active motion of fingers was 215 degrees. Static twopoint discrimination of fingertip ranged from 8 to 13 mm. On the follow-up, computerized tomography showed wellpreserved radio-capitate joint space without any arthritic changes. While performing hand replantation after amputation at the radiocarpal or midcarpal level, proximal row carpectomy is a useful procedure to preserve joint motion of the wrist in selected cases.

Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience

“…[6] Among macro replantations, amputations at the level of the wrist joint are thought to have the most favourable outcomes and to do better than replantations at other levels of arm and forearm (Meyer, 1985). [11] The skeletal management in cases of wrist replantations has been considered by Chow et al (1983) [9] , Meyer (1985) [11] and Vanstraelen et al (1993) [13] who all feel that the most favourable procedure for bone management should be considered according to individual circumstances with options including primary arthrodesis of the wrist joint, proximal row carpectomy [14] or some type of primary arthroplasty. In our study, we have done proximal row carpectomy and stabilized the wrist with k-wires for a period of 4 weeks.…”

Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

“…2A,B) 4 . This technique is occasionally utilized in the setting of replantation for the above reasons [60][61][62][63][64][65] .…”

Heterotopic Transarticular Replantation: A Functional Reconstruction Design for a Mutilated Hand with Multiple Digit Involvement

“…One case was a thumb avulsion that had been fixed with Kirschner wires 12 . The other was a hand amputation from the level of the wrist that had been treated with a proximal row carpectomy, Kirschner-wire immobilization, and capsular repair 13 .…”