Proximal row carpectomy with interposition arthroplasty using both capsular flap and acellular human dermal matrix.

BACKGROUND: In cases of wrist arthritis, proximal row carpectomy (PRC) has been widely utilized and shown favorable long-term outcomes. However, its applicability is limited in cases where arthritis extends to the lunate fossa or capitate. Recently, surgical approaches combining various methods of interposition arthroplasty have been introduced to overcome these drawbacks. The purpose of this study was to perform PRC and interposition arthroplasty with dorsal capsule and acellular dermal matrix(ADM),and analyze the clinical outcomes of these procedures. METHODS: Fourteen cases who underwent PRC and interposition arthroplasty using both dorsal capsular flap and ADM were retrospectively recruited. The researchers assessed the patients' Visual Analog Scale (VAS) pain score, Disabilities of the Arm, Shoulder and Hand (DASH) scores, range of motion (ROM), retear, and radiocarpal distance (RCD). RESULTS: One year post-surgery, both the VAS pain scores, DASH scores, and ROM showed statistically significant improvement compared to before the surgery. Upon reviewing the radiological results, the postoperative mean RCD was 4.8 ± 0.8 mm and one year follow up mean RCD was 3.6 ± 0.5 mm at one year post-surgery. Moreover, in the one year follow-up, there was no observed failure of the allodermis graft in any of the cases. CONCLUSION: The PRC and interposition arthroplasty with ADM demonstrated significantly improved clinical outcomes after surgery, showing a maintain of RCD without graft failure effectively.

Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis.

PURPOSE: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. METHODS: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. RESULTS: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. CONCLUSIONS: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Dorsal lunate dislocation and en bloc proximal row carpectomy: a case report.

An unhelmeted 59-year-old male involved in a motorcycle accident presented with a right dorsal lunate dislocation in the context of a polytrauma evaluation. Soft-tissue attachments were minimal across the carpus, which allowed for an en bloc proximal row carpectomy. Two-year follow-up yielded a satisfactory outcome given the high energy injury mechanism. Proximal row carpectomy is a useful tool which preserves wrist range of motion in the acute trauma setting and is durable, as demonstrated by our patient's postoperative mobilization using a wheelchair.

Proximal Row Carpectomy With Soft Tissue Interposition: A Systematic Review of Clinical Outcomes.

Proximal row carpectomy (PRC) with soft tissue interposition arthroplasty (STIA) presents an alternative approach to addressing wrist arthritis patterns involving the capitate and/or lunate fossa, in lieu of wrist arthrodesis. This systematic review aimed to evaluate clinical outcomes and techniques associated with PRC-STIA in patients with advanced wrist arthritis. We conducted a systematic review using databases including PubMed, Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. Inclusion criteria involved articles reporting outcomes of patients who underwent PRC-STIA with at least 1 relevant outcome. The analysis encompassed 8 studies involving 106 patients (108 wrists) meeting the inclusion criteria. A majority of patients were men (69%, n = 88), with a mean age of 54.4 ± 12.7 years and an average follow-up of 4.8 ± 6.3 years. Dorsal capsule was the most commonly interposed tissue (63%, 5 out of 8 studies). Patients receiving STIA achieved comparable patient-reported outcome measures scores to those undergoing PRC alone. Postoperative pain, measured by the Visual Analog Scale, averaged 3.7 ± 0.6. The Disabilities of the Arm, Shoulder, and Hand score averaged 27.8 ± 8, while the Patient-Rated Wrist Evaluation score averaged 41.5 ± 25.9. Five complications were reported in three studies. The addition of STIA into PRC for patients with capitate and/or lunate fossa cartilage degeneration yielded outcomes akin to traditional PRC, improving wrist function, pain, and grip strength in a safe and straightforward manner. Future research should prioritize high-quality comparative studies, extended follow-up periods, and standardized core outcome measures for a more comprehensive understanding of its role in wrist arthritis treatment.

A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019.

PURPOSE: The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States. METHODS: The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region. RESULTS: From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (-52.2% and -54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined -35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%). CONCLUSIONS: Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Management of Patients With Post-Traumatic Wrist Flexor Contracture by Carpectomy and Wrist Fusion.

Post-traumatic wrist flexor contracture is most commonly seen in major trauma affecting the hand, wrist, and forearm. It produces debilitating complications affecting the quality of life, often requiring multiple staged surgeries, and prolonged rehabilitation with physiotherapy to yield functional improvement. Wrist flexion contracture correction is the first surgery performed to reduce the deformity and improve the functional status of the hand. Releasing the wrist flexion contracture due to stretch on the contracted structures could cause a vascular compromise of the hand and skin deficit, which needs flap cover. On the other hand, removing the carpal bones reduces the length of the extremity and makes the existing skin adequate, with the wrist in the neutral position. This procedure avoids the need for a flap and avoids the stretch of blood vessels in bringing the wrist to the neutral position. A retrospective study was performed on three patients who presented to our institution, i.e., Sri Ramachandra Institute of Higher Education and Research, Chennai, India, and underwent carpectomy and wrist fusion for correction of post-traumatic wrist flexor contracture between December 2019 and July 2021, with follow-up extending to a maximum of 18 months. The three patients underwent prior surgeries at different hospitals following injury and later presented at our institution for further management and subsequently underwent surgeries and extensive rehabilitation to improve wrist and hand function. The patients underwent a staged procedure for correction of wrist contracture by soft tissue release and carpectomy, followed by wrist arthrodesis. Postoperatively, none of the patients had neurovascular complications or complications related to wound healing. Hence, carpectomy and wrist fusion are safe procedures to correct the wrist flexion contracture without complication and motivate the patient to undergo further surgeries to improve hand function.

Aspergillus fumigatus Septic Arthritis of the Wrist: A Report of a Rare Case in an Immunocompromised Patient.

Aspergillus fumigatus is a saprophytic fungus encountered as a pathogen in airborne lung infections. Although it commonly causes pulmonary infectious diseases, when disseminated, it may cause a systemic infection termed invasive aspergillosis, which is associated with high mortality and morbidity. Virtually, all organ systems may be involved. However, the musculoskeletal system is relatively uncommon. Here, we present a case of invasive aspergillosis in an immunocompromised patient involving the wrist joint, an exceedingly rare site. Our treatment choice is serial open debridement, irrigation, and intravenous antibiotics. This case study exemplifies the potential challenges in the identification and treatment of such an uncommon clinical condition. A thorough clinical and microbiological evaluation is essential for accurate diagnosis of fungal septic arthritis of the wrist. Aggressive early surgical treatment combined with appropriate early intravenous antibiotics is crucial for eradicating joint infection.

Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years.

The present study compares the postoperative clinical, radiological, and patient-reported functional results between the surgical procedures Proximal Row Carpectomy and Limited Carpal Fusion, in the treatment of SLAC and SNAC conditions of the wrist. 15 Proximal Row Carpectomy patients and 45 Limited Carpal Fusion patients were included in the study. Postoperative outcomes were assessed and compared for pain at load, range of motion, grip strength, Quick-DASH, and satisfaction. A radiological assessment was performed at the follow-up. The Proximal Row Carpectomy patients had a mean age of 60 years (range 31-77) and a mean follow-up of 42 months. The Limited Carpal Fusion patients had a mean age of 58 years (range 35-76) and a mean follow-up of 41 months. The patients treated with Limited Carpal Fusion performed significantly better regarding pain, radial-ulnar motion, and the Quick-DASH (p = 0.002, p = 0.003, and p = 0.002), respectively. The grip strength difference between the treatment groups was stratified for gender and was found significantly better for men in the LCF-treated patients, but not different for women (p = 0.03, p = 0.26), respectively. Differences in flexion-extension between the groups were insignificant (p = 0.525). A higher conversion rate to total wrist fusion was observed in the patients treated with the Proximal Row Carpectomy. All the Proximal Row Carpectomy patients had osteoarthritis at follow-up, whereas it was seen in 19% of the Limited Carpal Fusion patients. The patient-reported satisfaction was substantially better for the Limited Carpal Fusion patients. In conclusion, among patients treated for SNAC and SLAC wrist conditions, besides the findings of flexion-extension, and grip strength which were found without difference for women the findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy. Further, preferably prospective studies are needed to confirm or reject our findings.Level of evidence: Retrospective, comparative cohort study, level III.

Effect of Proximal Row Carpectomy and Wrist Arthrodesis on the Resting Length of Extrinsic Digit Flexor Tendons: A Cadaveric Study.

Background Spastic joint contractures remain a complex and challenging condition. For patients with upper extremity spastic dysfunction, improving the muscle balance is essential to maximize their hand function. Multiple procedures, including proximal row carpectomy (PRC) and wrist arthrodesis (WA), are considered among the different surgical alternatives. However, the biomechanical consequences of these two procedures have not been well described in current literature. Hence, the objective of our study is to assess the change in the extrinsic digit flexor tendon resting length after proximal row carpectomy and wrist arthrodesis. Methods Six fresh-frozen cadaver upper extremities (four females and two males) with no obvious deformity underwent dissection, PRC, and WA. All the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and flexor pollicis longus (FPL) tendons were marked proximally 1-cm distal to their respective myotendinous junction and cut distally at the marked point. The overlapping segment of each distal flexor tendon from its proximal mark was considered the amount of flexor tendon resting length change after PRC and WA. A descriptive evaluation was performed to assess the increment in tendon resting length. Additionally, a regression analysis was performed to evaluate the relation between the tendon resting length and the proximal carpal row height. Results Following PRC and WA, the mean digit flexor tendon resting length increment achieved across all tendons was 1.88 cm (standard deviation [SD] = 0.45; range: 1.00-3.00 cm). A weak direct relationship ( R = 0.0334) between the increment in tendon resting length and proximal carpal row height was initially suggested, although no statistical significance was demonstrated ( p = 0.811). Conclusion This study provides an anatomic description of the increased extrinsic digit flexor tendon resting length after PRC and WA in cadaveric specimens. Findings provide a useful framework to estimate the amount of extrinsic digit flexor resting length increment achieved after wrist fusion and the proximal carpal row removal.

The Effect of Proximal Row Carpectomy and Trapeziectomy on First Ray Stability: A Cadaveric Study.

PURPOSE: Wrist and thumb pathology can coexist leading to potential indications for proximal row carpectomy (PRC) and trapeziectomy. In this setting, the axial stability of the first ray is not known. We sought to evaluate axial subsidence of the first metacarpal in cadavers following trapeziectomy and trapeziectomy with PRC to determine the mechanical effects of the procedures performed concurrently. METHODS: Eleven fresh-frozen cadaveric distal forearm specimens were used in this study. The specimens were fixed in cement and mounted to a material test system frame. A predetermined force (20 N) was applied to the thumb metacarpal to simulate forces observed with lateral pinch. Axial displacement of the thumb metacarpal was measured. The application of force was repeated following trapeziectomy on each hand and then again following PRC. Analysis was performed to compare thumb metacarpal subsidence of the 3 groups: native, trapeziectomy, and trapeziectomy with PRC. RESULTS: Before trapeziectomy, native cadaver specimens had an average of 5.1 ± 1.9 mm of thumb metacarpal subsidence under the material test system load (20 N), compared to 16.2 ± 3.4 mm following trapeziectomy, and 25.0 ± 5.5 mm for trapeziectomy with PRC. CONCLUSION: We observed a significant increase in thumb metacarpal subsidence following concurrent trapeziectomy with PRC when compared to trapeziectomy alone. Our results suggest that performing both operations together would lead to a substantial risk of first ray subsidence. CLINICAL RELEVANCE: When treating concurrent basilar thumb and wrist arthritis, it may be more effective to stage the procedures or use a form of thumb metacarpal suspension or arthrodesis.

Immediate Proximal Row Carpectomy for Severe Perilunate Dislocation Injuries: A Minimum 5-Year Follow-Up.

Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).

Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review.

A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.

Long-term results of first row carpectomy with proximal capitate resurfacing using a pyrocarbon implant.

The functional results of proximal row carpectomy with a proximal capitate resurfacing using a pyrocarbon implant were evaluated in a retrospective, multicentric, multi-operator study. The outcomes of patients operated on at five surgical centres between January 2005 and December 2018 were reviewed. The data were collected by an independent observer during standardized consultations. Based on 30 patients with a mean follow-up of 7 years, the median range of flexion and extension was 65° and the median radioulnar tilt was 45°. The median Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 14 and the improvements in strength and pain were good. Compared with the preoperative values, significant improvements were seen in the flexion and extension range of motion, radioulnar tilt and pain score. No postoperative complications were recorded.Level of evidence: IV.

Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review.

Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.

Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients.

PURPOSE: Proximal row carpectomy (PRC) is a motion-sparing procedure with good patient-reported and clinical outcomes. Although some studies have investigated the risk of conversion to total wrist arthrodesis (TWA) after PRC, additional larger studies evaluating the specific risk factors that lead to failure are required. This study aimed to investigate the patient and procedure factors that are associated with increased risk for conversion to TWA in a large cohort of patients who underwent PRC. METHODS: The current procedural technology codes identified patients in a National Veteran's Health database undergoing a PRC over a 26-year period. Risk factors of interest comprised age, posterior interosseous nerve neurectomy, wrist arthritis pattern, bilateral surgery, smoking, comorbidities, and preoperative opioid use. The primary outcome was the rate of conversion to TWA. Cox proportional hazard regression was used to create hazard ratios of selected factors for reoperation. RESULTS: There were 1,070 PRCs performed, with a mean follow-up of 79.8 ± 59.6 months. A total of 5.3% (57/1,070) wrists underwent conversion to TWA. Younger age at the time of PRC (<50 years) significantly increased the risk of TWA (hazard ratio, 3.8; 95% confidence interval, 2.2-6.6). With every 1-year increase in age, there was a reduction of 4% (hazard ratio, 0.96; 95% confidence interval: 0.94-0.98) in the hazard of conversion to TWA. No other factors, including concomitant posterior interosseous nerve neurectomy or bilateral PRC, increased the risk of conversion to TWA. CONCLUSIONS: Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. Younger patient age increases the risk of conversion to arthrodesis, whereas posterior interosseous nerve neurectomy, bilateral PRCs, and comorbidity status do not appear to have an impact on the risk of arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Comparison of Clinical Outcomes in Open and Arthroscopically-Assisted Mini Open Proximal Row Carpectomy for Lichtman Stage IIIB and IIIC Kienböck Disease.

PURPOSE: Proximal row carpectomy (PRC) can be performed in the late stages of Kienböck disease using the traditional open technique or arthroscopically. In this study, we describe the arthroscopically-assisted mini-open PRC technique. The aim of the study was to compare the functional results with the open PRC technique in advanced-stage Kienböck disease. METHODS: The medical records of patients with Kienböck disease who underwent open PRC between 2006-2010 (Cohort A) and arthroscopically-assisted PRC (AAPRC) between 2010-2018 (Cohort B) were analyzed. The Quick Disabilities of the Arm, Shoulder, and Hand scores, visual analog scale, and Modified Mayo Wrist Scores were compared, which were obtained at the early postoperative (third month) and final follow-up. RESULTS: Cohort A had 14 and Cohort B 21 patients. The preoperative, early, and final mean visual analog scale scores were 7, 3, and 0.3, respectively, for Cohort A, and 7, 0.3, and 0.1, respectively, for Cohort B. The preoperative mean Quick Disabilities of the Arm, Shoulder, and Hand scores decreased from 69 to 34 at the third-month and 6.1 on the final follow-up visit for Cohort A and from 77 to 18, and 5 for Cohort B. The final Mayo wrist scores were excellent in 4, good in 4, and moderate in 6 of the Cohort A patients, and excellent in 11, good in 8, and moderate in 2 of the Cohort B patients. Mean flexion increased to 52° from 43° for Cohort A and to 62° from 41° for Cohort B. CONCLUSIONS: AAPRC, compared to the open PRC, resulted in increased wrist motion and increased Mayo wrist scores in the long-term. Also, the third-month patient-related outcomes revealed favorable results in the AAPRC group. We attribute these findings to the earlier initiation of postoperative wrist motion and the less invasive character of the AAPRC procedure. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Pre-operative imaging for surgical decision-making and the frequency of wrist arthrodesis and carpectomy procedures: a scoping review.

OBJECTIVES: Our objectives were to (1) analyze the imaging modalities utilized pre-operatively that influence surgical decision-making for wrist arthrodesis and carpectomy procedures and (2) determine the type and frequency of these procedures for the treatment of wrist arthritis. MATERIALS AND METHODS: This review was performed according to the guidelines of PRISMA Extension for Scoping Reviews. Using PubMed, Embase, and Scopus, peer-reviewed literature from 2011 to 2022 was searched for use of imaging in pre-operative decision-making for wrist arthrodesis and carpectomy surgical procedures. Data were compiled to determine the type(s) of imaging modalities used pre-operatively and types of surgical techniques reported in the literature. RESULTS: Of 307 articles identified, 35 articles satisfied eligibility criteria, with a total of 1377 patients (68% men; age mean, 50.9 years [range, 10-81]) and 1428 wrist surgical interventions. Radiography was reported for pre-operative planning in all articles for all patients. Pre-operative cross-sectional imaging was reported in 2 articles (5.7%), but no articles reported detailed data on how CT or MRI influenced pre-operative wrist arthrodesis and carpectomy procedure decision-making. A dozen different types of surgical techniques were reported. The four most common procedures were four-corner arthrodesis with scaphoid excision (846, 59%), proximal row carpectomy (239, 17%), total wrist arthrodesis (130, 9%), and scaphocapitate arthrodesis (53, 4%). CONCLUSION: Radiography is always used in pre-operative decision-making, but the literature lacks data on the influence of CT and MRI for selecting among a dozen different types of wrist arthrodesis and carpectomy procedures.

A Case for Acute Proximal Row Carpectomy for Perilunate Injuries.

Background: Perilunate injuries are complex injuries typically arising from high-energy injuries to the wrist. Standard treatment involves open reduction and internal fixation with ligamentous reconstruction; however, outcomes are fraught with complications including pain, stiffness, and arthrosis. Several case reports have demonstrated the role of proximal row carpectomy as a salvage procedure for complex carpal trauma in the setting of significant cartilage injury or bone loss. The authors believe that proximal row carpectomy may be an appropriate acute treatment in certain patient populations, with functional results similar to those obtained with ligamentous reconstruction. Methods: A retrospective review of two cases with perilunate dislocations managed with primary proximal row carpectomy are presented. Results: At greater than 1-year follow-up, both patients had stable radiocarpal alignment. Quick-DASH scores were 22.7 and 27.3. Conclusion: Primary proximal row carpectomy is a treatment option in the acute setting for perilunate injuries in elderly, lower-demand patients. Functional results are similar to those obtained with ligamentous reconstruction, with a shorter recovery period. Level of Evidence: IV.

[Dislocation due to injury with trajectory in the scaphoid-trapezoid-trapezoid periscaphoid-perisemilunar bones. Case report and literature review]. / Luxación por lesión con trayecto en los huesos escafoide-trapecio-trapezoidea periescafo-perisemilunar. Reporte de caso y revisión de la literatura.

INTRODUCTION: dislocations of carpal bones without associated fractures are considered a rare injury, the most common mechanism of injury being axial loading with wrist in extension plus ulnar deviation. The literature reports a wide variety of complex carpal injuries, even so, it is possible to identify previously undescribed injuries. OBJECTIVE: to present an atypical case of a patient with an injury to the midcarpal stabilizing mechanism and the stabilizing mechanism of the proximal row of the wrist following trauma to the hand that required carpectomy as definitive surgical treatment. PRESENTATION OF CASE: a 48 year old male patient is presented who is admitted to our hospital unit after presenting injury to the left hand after being run over by a motor vehicle, with axial load mechanism, presenting deformity in the left thoracic extremity, fracture of the proximal metaphysis of the second phalanx of the third finger as well as dislocation of the proximal interphalangeal joint, with traumatic amputation of the second phalanx of the fourth finger plus extensor injury in zone V of the fifth finger with loss of skin coverage of the fourth and fifth finger, attending our hospital unit 24 hours after the injury. CONCLUSIONS: carpal bone dislocations are an orthopedic emergency, with 20% going unnoticed in trauma centers. Early closed reduction is the initial treatment to avoid severe complications, however, surgical treatment is the gold standard for fixation. Carpectomy is considered a mostly adequate sequelae management treatment, however it is well accepted for complex injuries to the wrist stabilization mechanisms, as it can be performed in a short surgical time and early rehabilitation can be initiated and functional ranges of motion can be achieved with low sequelae.

INTRODUCCIÓN: las luxaciones de los huesos del carpo sin presentar fracturas asociadas se considera una lesión infrecuente; el mecanismo de lesión más común es la carga axial con muñeca en extensión más desviación cubital. La literatura reporta una gran variedad de lesiones complejas del carpo; aun así, es posible identificar lesiones no descritas previamente. OBJETIVO: presentar caso atípico de paciente con lesión a nivel del mecanismo estabilizador medio-carpiana y estabilizador de la fila proximal de la muñeca posterior a traumatismo en mano que requirió carpectomía como tratamiento quirúrgico definitivo. PRESENTACIÓN DEL CASO: paciente masculino de 48 años de edad, quien ingresa a nuestra unidad hospitalaria tras sufrir lesión en mano izquierda posterior a ser arrollado por vehículo automotor, con mecanismo de carga axial, presentando en extremidad torácica izquierda deformidad hacia volar, fractura de metáfisis proximal de segunda falange del tercer dedo así como luxación de articulación interfalángica proximal, con amputación traumática de segunda falange del cuarto dedo más lesión extensora en zona V del quinto dedo con pérdida de cobertura cutánea del cuarto y quinto dedos. Acude a nuestra unidad hospitalaria 24 horas después de la lesión. CONCLUSIONES: las luxaciones en huesos del carpo es una urgencia ortopédica, pasando desapercibidas en 20% en centros de traumatología. La reducción cerrada temprana es el tratamiento inicial para evitar complicaciones severas; sin embargo, el tratamiento quirúrgico es el estándar de oro para la fijación de las mismas. La carpectomía se considera un tratamiento mayoritariamente para el manejo adecuado de secuelas; sin embargo, es bien aceptado para las lesiones complejas que se presentan en los mecanismos estabilizadores de la muñeca, dado a que se puede realizar en un tiempo quirúrgico y se puede iniciar una rehabilitación temprana, con lo que se pueden alcanzar rangos de movimientos funcionales y con bajo grado de secuelas.

Advanced Arthritis of the Carpus: Preoperative Planning Practices of 337 Hand Surgeons.

Background Surgical procedure selection for carpal arthritis depends on which articular surfaces are affected, but there is no consensus on how to preoperatively evaluate cartilage surfaces. Despite advances in cross-sectional imaging, the utility of advanced imaging for preoperative decision-making has not been well established. Objectives Our objective was to assess if there is an added value to presurgical advanced imaging or diagnostic procedures in planning for carpal arthrodesis or carpectomy and to determine what imaging or diagnostic procedures influence surgical treatment options. Methods A seven-question survey was sent to 2,400 hand surgeons. Questions assessed which articular surfaces surgeons consider important for decision-making, which imaging modalities surgeons employ, and how often surgeons utilize diagnostic arthroscopy before performing carpectomy or arthrodesis procedures. Results A total of 337 (14%) surveys were analyzed. The capitolunate articulation (alone or in combination) was most frequently reported to impact surgical decision-making (48.1%). Most surgeons (86.6%) reported that standard plain radiographs are usually sufficient. Few surgeons reported always obtaining magnetic resonance imaging (MRI) or computed tomography (CT), with 44.2% of surgeons believing that MRI is never useful and 38.4% believing that CT is never useful. Most surgeons (68.2%) reported that they never perform wrist arthroscopy as part of their decision-making process. Conclusions This study provides information on the decision-making process in the surgical management of carpal arthritis. Given advances in cross-sectional imaging, further studies are needed to determine the utility of MRI and CT for the planning of surgical procedures in the treatment of arthritis of the carpus. Level of Evidence Level 4.