Scientific article
Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years

https://doi.org/10.1016/j.jhsa.2014.12.035Get rights and content

Purpose

To compare the long-term outcomes of proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) in a consecutive series of patients surgically treated between 1989 and 1998 in a single teaching hospital.

Methods

We included 12 patients (14 wrists) in the PRC group and 8 patients (8 wrists) in the FCA group. Mean follow-up time was 17 years. We compared functional outcome measures (range of motion and grip strength) and patient-reported outcome measures (visual analog score for pain, Mayo Wrist Score, and Michigan Hand Questionnaire). Radiographic evaluation of joint degeneration using the Culp and Jebson scoring system and postoperative complications were assessed for both groups.

Results

Active range of motion was slightly better after PRC. There were no differences in grip strength and patient-reported outcomes between groups. Severity of degenerative changes did not differ between groups and was not correlated with pain scores. The FCA group showed more postoperative complications.

Conclusions

Considering the objective and patient-reported outcomes of this study, both types of surgery perform well in the long run. Proximal row carpectomy seems to result in slightly better movement of the wrist with fewer surgical complications and no need for hardware removal. Moreover, postoperative immobilization time was much shorter.

Type of study/level of evidence

Therapeutic III.

Section snippets

Subjects

This was a nonrandomized, retrospective cohort study. All patients who were treated with either PRC or FCA between 1989 and 1998 at one teaching hospital were eligible for the study. Our medical ethical committee approved the study. Eligible candidates (n = 69) were identified and, if contact data could be traced, they were invited by letter and phone to participate in the study.

Outcome measures

After participants gave informed consent, they were invited to the outpatient clinic. There, a hand therapist

Study participation

Figure 1 shows a flow diagram of patient inclusion. Demographic data and indications for surgery are summarized in Table 1, Table 2. In the PRC group, 2 patients underwent the same type of surgery in both wrists, 6 patients had previous surgery in the treated wrist, and 1 patient had previously sustained an amputation of the opposite hand. In the FCA group 2 patients had previous surgery in the treated wrist.

Baseline characteristics and indication for surgery did not differ significantly

Discussion

Mulford et al2 showed that patients who underwent PRC or FCA performed well on all scales. However, the follow-up period of the comparative studies included in their review did not exceed 6 years.8 In our study, with an average follow-up of 17 years, we found that patients in both groups continued to perform well. With regard to the PRC procedure, this finding is in agreement with previous long-term results.21

Some studies6, 7, 9, 11, 13 suggested that PRC may perform better on wrist motion than

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    Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.