[Proximal row carpectomy in the treatment of degenerative arthritis of the wrist].

PURPOSE OF THE STUDY

To evaluate the outcome in patients treated by proximal row carpectomy at a follow-up of at least 12 months.

MATERIAL

A total of 28 patients were treated by proximal row carpectomy for degenerative arthritis of the wrist due to previous trauma to the wrist or avascular necrosis of the lunate. Of them, 24 underwent a follow-up examination at least 12 months post-operatively. Proximal row carpectomy was indicated in 11 patients for scaphoid non-union advance collapse (SNACwrist), in five patients for scapholunate advanced collapse (SLAC-wrist), in four patients for inveterate dislocation of the wrist, and in four patients for avascular necrosis of the lunate. Ten patients with proximal row carpectomy were simultaneously treated by partial resection of the posterior interosseous nerve and two patients by limited radial styloidectomy. In one patient we performed distraction resection arthroplasty of the wrist using the Fitzgerald method.

METHODS

The follow-up clinical and radiological examinations were performed after a minimum of 12 months post-operatively.We evaluated the range of wrist motion, grip strength, the presence of resting pain and pain dusing physical activities and the patient's satisfaction with the treatment outcome. By radiological examination we assessed radiocapitate joint degeneration and translation of the capitate bone in relation to the lunate facet of the radius. The differences between the results of pre- and post-operative clinical examinations were statistically evaluated using the Student's t-test, Sign test, Mann-Whitney test, and Wilcoxon signed rank test. The results were considered to be significant if p < 0.05.

RESULTS

Improvements in the range of motion in the flexion-extension arch, dorsal flexion, radial deviation and grip strength, expressed as percentages of these values for the opposite, unaffected wrist, were statistically significant. The differences in palmar flexion and ulnar deviation were statistically insignificant. Pain relief at rest and during physical activities was statistically significant. At the follow-up examination most patients (87.5%) reported an overall improvement. The difference in overall improvements between the patients with and without partial resection of the posterior interosseous nerve was not statistically significant.

DISCUSSION

The advantages of this procedure involve its technical simplicity, maintenance of wrist motion, satisfactory grip strength and pain relief, and a relatively low occurrence of post-operative degenerative wrist changes. These changes are not in correlation with functional complaints.

CONCLUSIONS

As shown by our results as well as published data, proximal row carpectomy is an effective surgical procedure for the treatment of degenerative arthritis of the wrist for its technical simplicity and favourable functional outcomes. Key words: proximal row carpectomy, SNAC-wrist, SLAC-wrist, avascular necrosis of the lunate, dislocation of the wrist, posterior interosseous nerve resection.