Advertisement

Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis

Published:December 13, 2019DOI:https://doi.org/10.1016/j.jhsa.2019.10.023

      Purpose

      Proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) are common salvage procedures for the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse. This study aimed to assess rates of reoperation and conversion to wrist fusion and to assess the factors associated with reoperation and conversion to wrist fusion for patients treated with PRC and FCA.

      Methods

      A retrospective chart review was performed evaluating 266 adult patients undergoing PRC or FCA at a single institutional system from 2002 to 2016. Demographic data, patient- and injury-specific data, reoperation and conversion rates, and complications were collected. Potential factors associated with reoperation or wrist fusion were evaluated using a bivariate, followed by a multivariable, analysis.

      Results

      Reoperation was more commonly performed in FCA (34%) than in PRC (11%) (odds ratio [OR], 3.4; 95% confidence interval [95% CI], 1.7–6.8) and occurred at a shorter postoperative interval. In a multivariable analysis for reoperation, manual labor was associated with reoperation in patients undergoing FCA (OR, 5.4; 95% CI, 1.5–19.1). In those undergoing PRC, anterior interosseous nerve (AIN) and/or posterior interosseous nerve (PIN) neurectomy was associated with a lower rate of reoperation (OR, 0.18; 95% CI, 0.06–0.57). In a multivariable analysis for conversion to wrist arthrodesis, intraoperative AIN and/or PIN neurectomy (OR, 0.18; 95% CI, 0.06–0.57) was associated with a lower rate of conversion to wrist fusion, and smoking (OR, 4.9; 95% CI, 1.8–13.5) was associated with a higher rate of conversion to wrist fusion. In the subanalysis of patients who underwent PRC, only AIN and/or PIN neurectomy was associated with lower rates of conversion to wrist arthrodesis (OR, 0.15; 95% CI, 0.04–0.56).

      Conclusions

      In our cohort, we observed that AIN and/or PIN neurectomy reduced the risk of reoperation and conversion to wrist arthrodesis after PRC. Smoking increased the odds of conversion to wrist arthrodesis in the combined PRC/FCA cohort; however, it is unclear whether this was due to smoking itself or whether the indications for PRC or FCA were affected, leading to this result.

      Type of study/level of evidence

      Prognostic IV.

      Key words

      JHS Podcast

      February 3, 2020

      JHS Podcast Episode 47

      This month Dr. Graham interviews Drs. Neal Chen, Kyle Eberlin and Jonathan Lans about their article entitled "Factors Associated With Reoperation and Conversion to Wrist Fusion After Proximal Row Carpectomy or 4-Corner Arthrodesis", which appears in the February 2020 issue of the Journal of Hand Surgery.

      Loading ...
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kiefhaber T.R.
        Management of scapholunate advanced collapse pattern of degenerative arthritis of the wrist.
        J Hand Surg Am. 2009; 34: 1527-1530
        • Strauch R.J.
        Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis—update on evaluation and treatment.
        J Hand Surg Am. 2011; 36: 729-735
        • Watson H.K.
        • Ballet F.L.
        • Haven N.
        The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.
        J Hand Surg Am. 1984; 9: 358-365
        • Mulford J.S.
        • Ceulemans L.J.
        • Nam D.
        • Axelrod T.S.
        Proximal row carpectomy vs four corner fusion for scapholunate (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrists: a systematic review of outcomes.
        J Hand Surg Eur Vol. 2009; 34: 256-263
        • Saltzman B.M.
        • Frank J.M.
        • Slikker W.
        • Fernandez J.J.
        • Cohen M.S.
        • Wysocki R.W.
        Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review.
        J Hand Surg Eur Vol. 2015; 40: 450-457
        • Berkhout M.J.L.
        • Bachour Y.
        • Zheng K.H.
        • Mullender M.G.
        • Strackee S.D.
        • Ritt M.J.
        Four-corner arthrodesis versus proximal row carpectomy: a retrospective study with a mean follow-up of 17 years.
        J Hand Surg A. 2015; 40: 1349-1354
        • Ali M.H.
        • Rizzo M.
        • Shin A.Y.
        • Moran S.L.
        Long-term outcomes of proximal row carpectomy: a minimum of 15-year follow-up.
        Hand (N Y). 2012; 7: 72-78
        • Wagner E.R.
        • Bravo D.
        • Elhassan B.
        • Moran S.L.
        Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients.
        J Hand Surg Eur Vol. 2014; 41: 484-491
        • Wall L.B.
        • Didonna M.L.
        • Kiefhaber T.R.
        • Stern P.J.
        Proximal row carpectomy: minimum 20-year follow-up.
        J Hand Surg Am. 2013; 38: 1498-1504
        • Wagner E.R.
        • Werthel J.D.
        • Elhassan B.T.
        • Moran S.L.
        Proximal row carpectomy and 4-corner arthrodesis in patients younger than age 45 years.
        J Hand Surg Am. 2017; 42: 428-435
        • Rahgozar P.
        • Zhong L.
        • Chung K.C.
        A comparative analysis of resource utilization between proximal row carpectomy and partial wrist fusion: a population study.
        J Hand Surg Am. 2017; 42: 773-780
        • Salomon G.D.
        • Eaton R.G.
        Proximal row carpectomy with partial capitate resection.
        J Hand Surg Am. 1996; 21: 2-8
        • Neubrech F.
        • Mühldorfer-Fodor M.
        • Pillukat T.
        • Van Schoonhoven J.
        • Prommersberger K.J.
        Long-term results after midcarpal arthrodesis.
        J Wrist Surg. 2012; 1: 123-128
        • Williams J.
        • Weiner H.
        • Tyser A.
        Long-term outcome and secondary operations after proximal row carpectomy or four-corner arthrodesis.
        J Wrist Surg. 2018; 7: 51-56
        • Gaston R.G.
        • Lourie G.M.
        • Floyd III, W.E.
        • Swick M.
        Pisotriquetral dysfunction following limited and total wrist arthrodesis.
        J Hand Surg Am. 2007; 32: 1348-1355
        • Medoff R.J.
        Essential radiographic evaluation for distal radius fractures.
        Hand Clin. 2005; 21: 279-288
        • Leroux T.
        • Wasserstein D.
        • Henry P.
        • et al.
        Rate of and risk factors for reoperations after open reduction and internal fixation of midshaft clavicle fractures: a population-based study in Ontario, Canada.
        J Bone Joint Surg Am. 2014; 96: 1119-1125
        • Kaas L.
        • Sierevelt I.N.
        • Vroemen J.P.
        • van Dijk C.N.
        • Eygendaal D.
        Osteoporosis and radial head fractures in female patients: a case-control study.
        J Shoulder Elbow Surg. 2012; 21: 1555-1558
        • Traverso P.
        • Wong A.
        • Wollstein R.
        • Carlson L.
        • Ashmead D.
        • Watson H.K.
        Ten-year minimum follow-up of 4-corner fusion for SLAC and SNAC wrist.
        Hand (N Y). 2017; 12: 568-572
        • Dacho A.K.
        • Baumeister S.
        • Germann G.
        • Sauerbier M.
        Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II.
        J Plast Reconstr Aesthetic Surg. 2008; 61: 1210-1218
        • Vanhove W.
        • De Vil J.
        • Van Seymortier P.
        • et al.
        Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist.
        J Hand Surg Eur Vol. 2008; 33: 118-125
        • Chedal-Bornu B.
        • Corcella D.
        • Forli A.
        • Moutet F.
        • Bouyer M.
        Long-term outcomes of proximal row carpectomy: a series of 62 cases.
        Hand Surg Rehabil. 2017; 36: 355-362
        • Croog A.S.
        • Stern P.J.
        Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up.
        J Hand Surg Am. 2008; 33: 1122-1130
        • Jebson P.J.
        • Hayes E.P.
        • Engber W.D.
        Engber, Proximal row carpectomy: a minimum 10-year follow-up study.
        J Hand Surg Am. 2003; 28: 561-569
        • Larsen C.F.
        • Jacoby R.A.
        • McCabe S.J.
        Nonunion rates of limited carpal arthrodesis : a meta-analysis of the literature.
        J Hand Surg Am. 1997; 22: 66-73
        • Siqueira L.
        • Diab M.
        • Bodian C.
        • Rolnitzky L.
        Adolescents becoming smokers: the roles of stress and coping methods.
        J Adolesc Health. 2000; 27: 399-408
        • Thomsen T.
        • Villebro N.
        • Møller A.M.
        Interventions for preoperative smoking cessation.
        Cochrane Database Syst Rev. 2014; 3: CD002294
        • Dellon A.L.
        Partial dorsal wrist denervation: resection of the distal posterior interosseous nerve.
        J Hand Surg Am. 1985; 10: 527-533
        • Weinstein L.P.
        • Berger R.A.
        Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation.
        J Hand Surg Am. 2002; 27: 8-12
        • Berge DJ Vanden
        • Kusnezov N.A.
        • Rubin S.
        • et al.
        Outcomes following isolated posterior interosseous nerve neurectomy: a systematic review.
        Hand (N Y). 2017; 12: 535-540
        • Sgromolo N.M.
        • Cho M.S.
        • Gower J.T.
        • Rhee P.C.
        Partial wrist denervation for idiopathic dorsal wrist pain in an active duty military population.
        J Hand Surg Am. 2018; 43: 1108-1112