title: Dynamic assessment of wrist after proximal row carpectomy and 4-corner fusion.
abstract: OBJECTIVE
  To investigate the effect of 4-corner fusion (4CF) or proximal row carpectomy (PRC) on wrist motion, strength, and outcome for 2 different cohorts from 2 separate institutions performing either 4CF or PRC for stage 2/3 scaphoid nonunion advanced collapse and scapholunate advanced collapse.
  
  
  METHODS
  The researchers assessed 46 subjects (24 4CF and 22 PRC), mean age 54 years, with a flexible electrogoniometer to measure maximum wrist motion and circumduction and compare it with the nonsurgical wrist. We analyzed the shape, size, rate, and smoothness of the circumduction curves. We assessed the maximum grip and sustainability of grip for 60 seconds using a digital grip analyzer. Patient evaluation measure and Michigan Hand Questionnaires measured patient-reported outcomes.
  
  
  RESULTS
  Flexion-extension in the surgically treated wrist was 50% of the nonsurgical side after a 4CF and 65% after a PRC. The radioulnar deviation component in circumduction of the surgically treated wrist was similar but markedly decreased after either procedure. The mean area of circumduction of the surgically treated wrist was similar after a PRC and a 4CF but was 30% of the nonsurgical wrist. The center of the circumduction ellipse after a PRC was closer than after a 4CF to the opposite wrist. The orientation of the plane of circumduction was 22° to the vertical flexion-extension plane after a PRC. After a 4CF, the plane was more vertical (9°). The peak grip strength and the area under the force time curve was 80% of the nonsurgical side after a PRC and 60% after a 4CF. The Michigan Hand Questionnaire result was 90% of the score for the nonsurgical hand after a PRC and 75% of score for the nonsurgical hand after a 4CF.
  
  
  CONCLUSIONS
  The PRC provided improved flexion-extension with a circumduction curve concentric with the nonsurgical wrist. The 4CF limited extension and ulnar deviation more than did a PRC.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands. Electronic address: hpsinghjk@gmail.com.
authors.forename: Harvinder P
authors.initials: HP
authors.lastname: Singh
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Brinkhorst
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Dias
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.
authors.forename: Thybout
authors.initials: T
authors.lastname: Moojen
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: Hovius
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, United Kingdom; Department of Hand Surgery, Erasmus MC, and the Hand and Wrist Clinic, Xpert Clinic, The Netherlands.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Bhowal
mesh_terms: D002348:Carpal Bones / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000601:surgery*; D010027:Osteotomy; D016059:Range of Motion, Articular / Q000502:physiology; D021361:Scaphoid Bone / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014955:Wrist Joint / Q000601:surgery*
keywords: 4-corner fusion; Proximal row carpectomy; arthrodesis; range of motion