Proximal row carpectomy: long-term results.
OBJECTIVE
To evaluate long-term clinical outcome of proximal carpectomy. Our assumption was that this intervention should result in long-term benefit, making a wrist painless, mobile, and functional, compatible with social and professional life, whatever the initial etiology of the degenerative wrist.


METHODS
We report a continuous single centre retrospective series of 24 patients. Objective (mobility, strength, radiographic evaluation) and subjective (pain, subjective wrist value, functional scores) functions were assessed by an independent observer. Surgery was performed mainly for Kienbock's disease, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists.


RESULTS
The follow-up lasted 116 months in average, during which pain was improved in all cases; 83% of the patients were satisfied with a mean score of 1.2 on a visual analogue scale (VAS) and 76% subjective wrist value (SWV) (disabilities of the arm, shoulder and hand [DASH]: 31). Wrist flexion-extension arc averaged 76 degrees , and the grip strength equivalent to 78% of the contralateral limb. Radiographic modification developed in 52% without any clinical impact. Three patients required arthrodesis and never felt comfortable with their carpectomy.


CONCLUSIONS
Our study shows a long-term efficacy of proximal row carpectomy. This treatment must be considered in the therapeutic arsenal for a degenerative and painful wrist, and it should no longer be regarded as a salvage procedure. Advantages of this intervention are obvious: technical simplicity, short rehabilitation, immediate functionality of the wrist and few complications.
Richou
J
J
Service de chirurgie orthopédique et traumatologique, faculté de médecine, hôpital de Cavale-Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France. julrichou@hotmail.com
Chuinard
C
C
Moineau
G
G
Hanouz
N
N
Hu
W
W
Le Nen
D
D
D000328:Adult; D000368:Aged; D005260:Female; D051225:Hamate Bone / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010020:Osteonecrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods* / Q000534:rehabilitation; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D018579:Patient Selection; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016879:Salvage Therapy; D021361:Scaphoid Bone / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome