Proximal Row Carpectomy Versus Four-Corner Arthrodesis as a Treatment for SLAC (Scapholunate Advanced Collapse) Wrist

Abstract

Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel syndrome following four-corner arthrodesis is intriguing. We also found significant differences in the duration of hospital stay and of postoperative sick leave in favour of proximal row carpectomy. If the cartilage on the capitate head is well preserved (Stages I-II), we prefer proximal row carpectomy because of the socio-economic benefits, the lower complication rate and the ease of the procedure. Degenerative changes following proximal row carpectomy may be a concern in young manual labourers, but have not been observed.

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

“…Severe pain was absent in our study, where the patients were basically able to perform their daily activities, without needing further carpal arthrodesis. Furthermore, a recent study found that the rate of complications such as carpal tunnel syndrome was higher and the duration of hospital stay was longer in the arthrodesis group [16]. We thus believe that proximal row carpectomy should be preferred if both procedures are indicated.…”

Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Arthritis—Update on Evaluation and Treatment

“…Vanhove et al 37 wrist arthrodesis and noted better outcomes with PRC. Dacho et al 38 preferred PRC for patients who required less grip strength at work.…”

Salvage Operations for Wrist Ligament Injuries with Secondary Arthrosis

“…Note that several studies show mildly better motion after PRC than after scaphoidectomy with 4CF, 1,[13][14][15][16][17] although not all studies support this distinction. 18,19 One clear difference between PRC and scaphoidectomy with 4CF is the complication rate needed for postoperative immobilization: complications were significantly more common after scaphoidectomy with 4CF, including nonunion, delayed union, and hardware-related problems, and the period of immobilization is greater for scaphoidectomy with 4CF. 12 In patients who cannot tolerate an extended period of wrist immobilization, or in heavy smokers in whom nonunion is a concern, PRC may be preferred.…”