title: Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review.
abstract: We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I-III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA bryan.m.saltzman@gmail.com.
authors.forename: B M
authors.initials: BM
authors.lastname: Saltzman
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Frank
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: W
authors.initials: W
authors.lastname: Slikker
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Fernandez
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
authors.forename: R W
authors.initials: RW
authors.lastname: Wysocki
mesh_terms: D001168:Arthritis / Q000503:physiopathology* / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D002348:Carpal Bones / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery
keywords: Four-corner arthrodesis; four-corner fusion; proximal row carpectomy; scaphoid nonunion advanced collapse; wrist arthrosis