Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four-corner arthrodesis

Wyrick, John D.; Stern, Peter J.; Kiefhaber, Thomas R.

doi:10.1016/s0363-5023(05)80144-3

Cited by 255 publications

(200 citation statements)

References 11 publications

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“…Multiple clinical studies reported successful pain relief with comparable results in terms of both motion and strength [2,6,7,11,13]. Fourcorner arthrodesis provides a satisfactory option for palmar midcarpal instability [4].…”

Section: Discussionmentioning

confidence: 99%

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Skie¹,

Grothaus

Ciocanel

et al. 2007

Hand (New York, N,Y.)

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Purpose Partial wrist arthrodesis is a commonly performed procedure for the treatment of posttraumatic wrist arthritis because of its ability to provide pain relief without sacrificing complete wrist motion. The purpose of this study was to evaluate the redistribution of force after fourcorner fusion and scaphoid excision, and to correlate the findings with the reported clinical outcomes. Methods Fifteen cadaveric wrists were used to study the biomechanics of the four-corner fusion. Pressure-sensitive film (super-low-pressure-indicating film-Pressurex, Sensor Products Inc, Madison, NJ) was inserted into the radiocarpal joint. Using the MTS 858 Mini Bionix (MTS System, Eden Prairie, MN), 50-kg loads (220 N) were applied to the wrists before and after simulated four-corner fusion and scaphoid excision. Statistically, we compared the pressure in the normal (intact) wrists versus four-corner fusion and scaphoid excision. The pressure measurements across the scaphoid fossa, lunate fossa, and triangular fibrocartilage complex (TFCC) were compared. Results There is a statistical significant difference between scaphoid, lunate, and TFCC mean total force when pre and post-fusion were compared (p=0.0001). Our study revealed a statistical significant decrease in the mean scaphoid total force after scaphoid excision and four-corner fusion (p=0.0001). We also found a subsequent increase in mean total force after scaphoid excision and four-corner fusion for the lunate fossa that did not reach statistical significance (p=0.08), and no difference in load across the TFCC area (p=0.995). Conclusions Our findings suggest that load is preferentially transferred to the radiolunate joint after scaphoid excision with four-corner fusion.

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Section: Discussionmentioning

confidence: 99%

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Skie¹,

Grothaus

Ciocanel

et al. 2007

Hand (New York, N,Y.)

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“…A non-union rate of 12% has been noted by Pisano, Piemer and Wheeler et al [10]. In another series [18] the authors had a 30% complication rate when they used limited carpal fusion in SLAC (scapholunate advanced collapse) wrists. They suggest that the patient should be made aware of the possibility of later conversion to a wrist fusion.…”

Section: Discussionmentioning

confidence: 84%

Wrist fusion versus limited carpal fusion in advanced kienbock's disease

Tambe

Trail

Stanley

2005

International Orthopaedics (SICO

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We treated 18 patients with advanced Kienbock's disease surgically. Six had total wrist fusions and 12 had limited carpal fusions. The average age was 39.6 yrs and the average follow up was 61.8 months and 66.8 months respectively. The visual analogue pain scores, the patient satisfaction scores and the SF 12 were better in the total wrist fusion group. The DASH (Disabilities of the Arm, Shoulder and Hand) scores, the range of movement and the grip strengths were better in the limited carpal fusions group but this was not statistically significant. Four patients with limited carpal fusions had a non-union that required revising. We believe that total wrist fusion should be offered earlier to patients with advanced stages of the disease, as there are less surgical failures, more satisfied patients, better post operative pain scores and consistent long-term results with less potential for further deterioration with time as compared to other treatment methods.Résumé Nous avons traité chirurgicalement 18 malades avec une maladie de Kienbock avancée. Six malades ont eu une arthrodèse radio-carpienne complète et 12 une arthrodèse carpienne limitée. L'âge moyen était de 39,6 ans et la moyenne de suivi était de 61,8 mois et 66,8 mois respectivement. La score analogique visuel de la douleur, la score de satisfaction des malades et le score SF 12 sont meilleurs dans le groupe fusion complète. Le score DASH (Invalidités Bras, Épaule et Main), l'amplitude de mouvement et la force de préhension étaient meilleurs dans le groupe des fusions carpiennes limitées mais ce n'était pas statistiquement significatif. Quatre malades avec une fusion carpienne limitée avaient une pseudarthrose qui a exigé une révision. Nous croyons que la fusion complète du poignet devrait être offerte plus précocement aux malades aux étapes avancées de la maladie, car il y aurait moins d'échec chirurgicaux, plus de patients satisfaits, de meilleurs résultats sur la douleur, et des résultats plus solides à long terme avec moins de risque de détérioration secondaire, comparée aux autres méthodes du traitement.

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“…Tomaino et al [10] found no significant difference in the pain scoring between 15 cases that had undergone proximal row carpectomy and nine cases that had undergone scaphoid excision and limited midcarpal arthrodesis according to the Bach Pain Score Standard [11]. In a similar comparison, Wyrick et al [12] reported that nine of 11 patients undergoing proximal row carpectomy and wrist arthroplasty experienced no postoperative pain and two had minimal pain, while ten of the 18 receiving scaphoid excision and limited carpal arthrodesis were free of pain, two had minimal pain, one moderate pain and five severe pain. In our study, seven cases were painless on activities of daily living postoperatively, two experienced occasional pain and one complained of moderate pain when performing heavy labour, but none of them required analgesic medication.…”

Section: Discussionmentioning

confidence: 95%

Clinical evaluation of proximal row carpectomy revealed by follow-up for 10–29 years

Liu

Zhou

Yang

et al. 2009

International Orthopaedics (SICOT)

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To investigate the long-term clinical results of proximal row carpectomy for treating chronic wrist injuries, we collected the postoperative results of ten patients who underwent this procedure between 1978 and 1996. The evaluation was based on Gartland and Werley and modified Green and O'Brien scoring systems. The follow-up ranged from ten to 29 years. Nine patients could perform daily activities properly, two experienced occasional pain and one moderate pain. Eight patients were rated as excellent, two were good, while none was fair or poor by the former scoring system. Seven patients were rated as good, three were fair and none was excellent or poor by the latter scoring system. No apparent degenerative change was found in the radiocapitate joints apart from a slight change in one patient. The operation is a dependable and durable procedure that results in satisfactory pain relief, improved functional wrist motion and grip strength, allowing most patients to resume their previous work.

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Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four-corner arthrodesis

Cited by 255 publications

References 11 publications

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Scaphoid Excision with Four-Corner Fusion: A Biomechanical Study

Wrist fusion versus limited carpal fusion in advanced kienbock's disease

Clinical evaluation of proximal row carpectomy revealed by follow-up for 10–29 years

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