title: Functional results after proximal row carpectomy to salvage a wrist.
abstract: Proximal row carpectomy is a movement-preserving procedure in the treatment of arthrosis of the wrist. We have retrospectively assessed the objective and subjective functional results after proximal row carpectomy. Assessment of outcome included measurement of range of movement (ROM), grip strength and self-assessment of pain relief with a visual analogue scale (VAS) and the Disabilities of arm, shoulder, and hand (DASH) questionnaire. Results were graded using the Mayo and Krimmer wrist scores. Fourty-five patients (mean age 48 (30-67) years) were evaluated with a follow-up of 32 (8-115) months. Underlying conditions included: degenerative arthritis secondary to scapholunate advanced collapse deformity, or chronic scaphoid non-union (n=35), Kienbock disease stage III (n=4), chronic perilunate dislocation and fracture-dislocation (n=4), avascular necrosis of the scaphoid (n=1), and severe radiocarpal arthrosis secondary to distal radial fracture (n=1). Active ROM for wrist extension and flexion was 70 degrees and mean radial and ulnar deviation 30.8 degrees . Grip strength was 51% of the unaffected side. The average DASH score was 26. The intensity of the pain, measured by VAS, was reduced by 44% after strenuous activities and by 71% at rest. The Mayo and Krimmer wrist scores were 55 and 62 points indicating good results; 32 patients returned to work and 25 patients to their former occupation. Our results show that proximal row carpectomy is a technically easy operation that preserves a satisfying ROM and pain relief, and is recommended when the head of the capitate and the lunate fossa are not affected by arthrosis.
authors.affiliation: Department for Hand, Plastic and Reconstructive Surgery -Burn Center, BG-Trauma-Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kremer
authors.forename: Michael
authors.initials: M
authors.lastname: Sauerbier
authors.forename: Markus
authors.initials: M
authors.lastname: Trankle
authors.forename: Adrian
authors.initials: A
authors.lastname: Dragu
authors.forename: Guenter
authors.initials: G
authors.lastname: Germann
authors.forename: Steffen
authors.initials: S
authors.lastname: Baumeister
mesh_terms: D000328:Adult; D000368:Aged; D002348:Carpal Bones / Q000601:surgery*; D050824:Carpal Joints / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D005599:Fractures, Ununited / Q000150:complications / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012667:Lunate Bone / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010003:Osteoarthritis / Q000150:complications / Q000601:surgery; D010020:Osteonecrosis / Q000150:complications / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D017060:Patient Satisfaction; D011885:Radius Fractures / Q000150:complications / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery