Modification of proximal row carpectomy (PRC) technique for adaptive wrist collapse (pilot study)

Introduction Proximal carpal row resection has been used for many decades as a “salvage procedure” for progressive wrist collapse. Improving the technique of its implementation, as well as introducing various modifications of the technique into practice are an important area for achieving better results of surgical treatment.

The purpose of this work was to demonstrate aspects of the modified proximal row carpectomy (PRC) technique and the immediate results of its use.

Materials and methods Eight patients aged from 24 to 57 years (seven men and one woman) were treated with the modified PRC technique. Treatment results were assessed using an adapted QuickDASH questionnaire, a visual analogue scale (VAS), based on patient satisfaction and radiographic results.

Results The average duration of surgical intervention was (149.0 ± 35.5) minutes. In the postoperative period, six patients (75 %) underwent fixation with an Ilizarov apparatus, the rest with a plaster splint. The average range of motion of flexion and extension was (67.5 ± 18.3)°, range: 40–95°. The patients had an average of (35.6 ± 16.13)° extension, range: 10–65° and (31.87 ± 10.9)° flexion, range: 10–45°. Patients reported decreased grip strength after surgery. Pain syndrome according to VAS at rest was equal to 0–1 points and 3–4 points when the affected limb was loaded. Six patients completed the QuickDASH survey, with a mean score of (14.83 ± 4.25) points. All patients are satisfied with the result of treatment and the absence of pain at rest. Patients returned to their usual work.

Discussion Unlike the conventional dorsal approach through the III–IV tendon canals, the use of two mini-approaches provides a better cosmetic effect and makes it easier to restore the integrity of the tendon canals, which are important for the prevention of desmogenic contractures. The use of the Ilizarov apparatus has proven to be the method of choice, providing absolute stability and reduction of pain in the postoperative period. For patients under 45 years of age with increased functional demands, a balanced approach is required when choosing PRC or intercarpal arthrodesis, depending on which functional parameters are more important to the patient.

Conclusion The analysis of short-term results of using the modified PRC technique shows that it reduces the invasiveness of the operation, improves its esthetic result, provides pain relief and a satisfactory range of motion and grip strength.

1. Forman TA, Forman SK, Rose NE. A clinical approach to diagnosing wrist pain. Am Fam Physician. 2005;72(9):1753-8.

2. Maklad M. Wrist arthritis and carpal advanced collapse- systematic review. Int J Orthop. 2020;7(6):1374-1378. doi: 10.17554/j.issn.2311-5106.2020.07.400

3. Laulan J, Marteau E, Bacle G. Wrist osteoarthritis. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S1-S9. doi: 10.1016/j.otsr.2014.06.025

4. Nissen KL. Symposium on cerebral palsy (orthopaedic section). Proc R Soc Med. 1951;(44):87-90.

5. Ely LW. An operation for tuberculosis of the wrist. JAMA. 1920;75(25):1707-1709. doi: 10.1001/jama.1920.02620510021009

6. Voltovsky AI. Adaptive collapse of the wrist: notion, classification, modern methods of diagnostics. Medical journal. 2012;(3):26-31. (In Russ.)

7. Borisch N, Haussmann P. Radiolunate arthrodesis in the rheumatoid wrist: a retrospective clinical and radiological longterm follow-up. J Hand Surg Br. 2002;27(1):61-72. doi: 10.1054/jhsb.2001.0681

8. Chamay A, Della Santa D, Vilaseca A. Radiolunate arthrodesis. Factor of stability for the rheumatoid wrist. Ann Chir Main. 1983;2(1):5-17. doi: 10.1016/s0753-9053(83)80073-8

9. Tubiana R, Thomine J-M, Mackin E. Examination of the hand and wrist. London: Martin Dunitz; 1996:185-197.

10. Viegas SF, Patterson RM, Peterson PD, et al. Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg Am. 1990;15(2):268-278. doi: 10.1016/0363-5023(90)90107-3

11. Watson HK, Ashmead D. Triscaphe fusion for chronic scapholunate instability. In: Gelberman RH. (ed). The wrist. New York: Raven Press; 1994:183-194.

12. Alnot JY. Guepar's total arthroplasty of the wrist in rheumatoid polyarthritis. Acta Orthop Belg. 1988;54(2):178-184.

13. Clayton ML. Surgical treatment at the wrist in rheumatoid arthritis: a review of thirty-seven patients. J Bone Joint Surg Am. 1965 Jun;47:741-750.

14. Cobb TK, Beckenbaugh RD. Biaxial total-wrist arthroplasty. J Hand Surg Am. 1996;21(6):1011-1021. doi: 10.1016/S0363-5023(96)80309-1

15. Divelbiss BJ, Sollerman C, Adams BD. Early results of the Universal total wrist arthroplasty in rheumatoid arthritis. J Hand Surg Am. 2002;27(2):195-204. doi: 10.1053/jhsu.2002.31728

16. Gupta A. Total wrist arthroplasty. Am J Orthop (Belle Mead NJ). 2008;37(8 Suppl 1):12-16.

17. Wu J, Sun J, Liu X, et al. Clinical analysis of distal radius core decompression for chronic wrist pain. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023;37(7):815-820. (In Chin.) doi: 10.7507/1002-1892.202303131

18. Smeraglia F, Basso MA, Famiglietti G, et al. Partial wrist denervation versus total wrist denervation: A systematic review of the literature. Hand Surg Rehabil. 2020;39(6):487-491. doi: 10.1016/j.hansur.2020.05.010

19. Kadiyala RK, Lombardi JM. Denervation of the Wrist Joint for the Management of Chronic Pain. J Am Acad Orthop Surg. 2017;25(6):439-447. doi: 10.5435/JAAOS-D-14-00243

20. Stern PJ, Agabegi SS, Kiefhaber TR, Didonna ML. Proximal row carpectomy. J Bone Joint Surg Am. 2005;87 Suppl 1(Pt 2):166-174. doi: 10.2106/JBJS.E.00261

21. Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision? J Hand Surg Am. 1994;19(1):134-142. doi: 10.1016/0363-5023(94)90237-2

22. Trumble TE, Salas P, Barthel T, Robert KQ 3rd. Management of scaphoid nonunions. J Am Acad Orthop Surg. 2003;11(6):380-391. doi: 10.5435/00124635-200311000-00002. Erratum in: J Am Acad Orthop Surg. 2004;12(1):33A.

23. Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC- wrist) in stage II. J Plast Reconstr Aesthet Surg. 2008;61(10):1210-1218. doi: 10.1016/j.bjps.2007.08.007

24. Chim H, Moran SL. Long-term outcomes of proximal row carpectomy: a systematic review of the literature. J Wrist Surg. 2012;1(2):141-148. doi: 10.1055/s-0032-1329547

25. Altaf W, Bhardwaj P, Sabapathy SR, Haseeb BA. A simple trick to excise the carpal bones during proximal row carpectomy. Indian J Plast Surg. 2018;51(1):101-102. doi: 10.4103/ijps.IJPS_213_17

26. Carter TI, Pansy B, Wolff AL, et al. Accuracy and reliability of three different techniques for manual goniometry for wrist motion: a cadaveric study. J Hand Surg Am. 2009;34(8):1422-1428. doi: 10.1016/j.jhsa.2009.06.002

27. Su Y. QuickDASH. J Physiother. 2014;60(3):167. doi: 10.1016/j.jphys.2014.06.003

28. El-Mowafi H, El-Hadidi M, Boghdady GW, Hasanein EY. Functional outcome of four-corner arthrodesis for treatment of grade IV scaphoid non-union. Acta Orthop Belg. 2007;73(5):604-611.

29. Wagner ER, Barras LA, Harstad C, et al. Proximal Row Carpectomy in Young Patients. JBJS Essent Surg Tech. 2021;11(1):e19.00054-e19.00054. doi: 10.2106/JBJS.ST.19.00054

30. Volgas DA, Harder I. Manual of Soft-Tissue Management in Orthopaedic Trauma. New York: AOTrauma Publ.; 2011:4-5.