Carpal height and postoperative strength after proximal row carpectomy or four-corner arthrodesis: Clinical, anatomical and biomechanical study.
Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are the two most commonly performed surgical procedures to treat wrist arthritis. Postoperative strength is one of the criteria for choosing between the two techniques. Some authors believe that strength is correlated with residual carpal height. The goal of this study was to determine if postoperative carpal height was predictive of postoperative strength. This study consisted of two parts: a clinical evaluation of grip strength after 4CA or PRC; anatomical and radiological measurements of carpal height before and after 4CA or PRC. Grip strength was better preserved after PRC (87.5%) than after 4CA (76.1%), when expressed relative to the opposite hand (P=0.053). There was a significant decrease in carpal height for the PRC group with a Youm's index of 0.37 versus 0.50 for the 4CA group (P<0.0001). Our clinical results and analysis of the literature indicate that 4CA is not superior to PRC when it comes to grip strength, whereas carpal height is significantly decreased after PRC. The decreased tendon excursion after PRC is balanced by an increase in joint stresses after 4CA.
Service d'orthopédie B, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France. Electronic address: pascale.laronde@gmail.com.
Pascale
P
Laronde
Service d'orthopédie B, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France.
Nicolas
N
Christiaens
Service d'orthopédie B, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France.
Aurélien
A
Aumar
Service d'orthopédie B, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France; Service de traumatologie, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France.
Christophe
C
Chantelot
Service d'orthopédie B, hôpital Roger-Salengro, rue Emile-Laine, 59037 Lille, France; Laboratoire d'anatomie, faculté de médecine de Lille, 1, place de Verdun, 59045 Lille cedex, France; Laboratoire d'automatique, de mécanique et d'informatique industrielle et humaine LAMIH, université de Valenciennes et du Hainaut-Cambrésis, Le Mont Houy, 59313 Valenciennes cedex, France.
Christian
C
Fontaine
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001696:Biomechanical Phenomena; D002348:Carpal Bones / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014955:Wrist Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
Arthrodèse des quatre os; Carpal height; Excursion tendineuse; Force de poigne; Four-corner arthrodesis; Grip strength; Hauteur du carpe; Proximal row carpectomy; Résection de la rangée proximale du carpe; Tendon excursion