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
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Article info
Publication history
Published online: December 13, 2019
Accepted:
October 15,
2019
Received:
October 1,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
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