Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?

Proximal row carpectomy (PRC) and limited intercarpal arthrodesis with scaphoid excision (LWF) are useful alternatives to wrist arthrodesis for treatment of degenerative wrist disorders secondary to scapholunate advanced collapse. Because consensus regarding the ideal motion-preserving option is lacking, we sought to better define the indications for and relative merits of PRC versus LWF. Twenty-four wrists treated for symptomatic scapholunate advanced collapse arthritis between 1980 and 1990 with either PRC or LWF were retrospectively reviewed at an average of 5.5 years postoperatively. At follow-up evaluation, satisfactory pain relief, grip strength, and functional performance were observed except in three patients with PRC, one of whom had developed symptomatic radiocarpal arthritis requiring conversion to arthrodesis. Differences in subjective and objective results between the two treatment groups were not statistically significant except for residual range of motion. Incomplete correction of lunate extension when LWF was performed resulted in diminished wrist extension, compared to PRC. Improvements in grip strength and range of motion were noted for at least 1 year after both procedures, and neither declined with time. A stage-dependent surgical approach to the symptomatic scapholunate advanced collapse wrist is advocated in light of comparable outcomes following both PRC and LWF. For wrists without capitolunate arthritis, PRC avoids the technical demands, lengthy postoperative immobilization, and risk of nonunion associated with LWF, but for stage III disease (capitolunate arthritis) pain relief may be unsatisfactory, and LWF is recommended.