Advertisement

Proximal Row Carpectomy Versus 4-Corner Fusion: Incidence, Conversion to Fusion, and Cost

Published:February 20, 2020DOI:https://doi.org/10.1016/j.jhsa.2019.12.010

      Purpose

      The primary objective of this study was to compare incidence, demographic trends, and rates of subsequent fusion between proximal row carpectomy (PRC) and 4-corner fusion (4CF) among patients in the United States.

      Methods

      A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from the years 2005 through 2014 among enrollees in the PearlDiver database. Regional distribution, demographic characteristics, annual incidence, comorbidities, and subsequent wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age- and sex-matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average direct cost.

      Results

      Patients undergoing 4CF and PRC did not have statistically significant differences in comorbidities. The incidence of the procedures among all subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,000) from 2005 to 2014. Comparing the matched cohorts, patients who underwent 4CF had a higher rate of subsequent fusion than those who underwent PRC (2.67% vs 1.79%). Readmission rates were not significantly different at 30 or 90 days. Average direct cost was significantly greater for 4CF than for PRC.

      Conclusions

      Both PRC and 4CF have been utilized at increasing rates in the past decade. Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates.

      Type of study/level of evidence

      Therapeutic III.

      Key words

      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

        • Krimmer H.
        • Lanz U.
        Post-traumatic carpal collapse. Follow-up and therapeutic concept [in German].
        Unfallchirurg. 2000; 103: 260-266
        • Krakauer J.D.
        • Bishop A.T.
        • Cooney W.P.
        Surgical treatment of scapholunate advanced collapse.
        J Hand Surg Am. 1994; 19: 751-759
        • Watson H.K.
        • Ballet F.L.
        The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.
        J Hand Surg Am. 1984; 9: 358-365
        • Watson H.K.
        • Ryu J.
        Evolution of arthritis of the wrist.
        Clin Orthop Relat Res. 1986; 202: 57-67
        • Wyrick J.D.
        • Stern P.J.
        • Kiefhaber T.R.
        Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis.
        J Hand Surg Am. 1995; 20: 965-970
        • Wyrick J.D.
        Proximal row carpectomy and intercarpal arthrodesis for the management of wrist arthritis.
        J Am Acad Orthop Surg. 2003; 11: 277-281
        • Luegmair M.
        • Houvet P.
        Effectiveness of four-corner arthrodesis with use of a locked dorsal circular plate.
        Clin Orthop Relat Res. 2012; 470: 2764-2770
        • Dacho A.
        • Grundel J.
        • Holle G.
        • Germann G.
        • Sauerbier M.
        Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist).
        Ann Plast Surg. 2006; 56: 139-144
        • Goldfarb C.A.
        • Stern P.J.
        • Kiefhaber T.R.
        Palmar midcarpal instability: the results of treatment with 4-corner arthrodesis.
        J Hand Surg Am. 2004; 29: 258-263
        • Ozyurekoglu T.
        • Turker T.
        Results of a method of 4-corner arthrodesis using headless compression screws.
        J Hand Surg Am. 2012; 37: 486-492
        • Bain G.I.
        • Watts A.C.
        The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years.
        J Hand Surg Am. 2010; 35: 719-725
        • Rhee P.C.
        • Shin A.Y.
        The rate of successful four-corner arthrodesis with a locking, dorsal circular polyether-ether-ketone (PEEK-Optima) plate.
        J Hand Surg Eur Vol. 2013; 38: 767-773
        • Liu M.
        • Zhou H.
        • Yang Z.
        • Huang F.
        • Pei F.
        • Xiang Z.
        Clinical evaluation of proximal row carpectomy revealed by follow-up for 10-29 years.
        Int Orthop. 2009; 33: 1315-1321
        • 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
        • 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
        • Stanley J.K.
        Re: Mulford JS, Ceulemans LJ, Nam D, Axelrod TS. 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.
        J Hand Surg Eur Vol. 2009; 34 (author reply 820): 819-820
        • Cohen M.S.
        • Kozin S.H.
        Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis.
        J Hand Surg Am. 2001; 26: 94-104
        • Berkhout M.J.
        • 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 Am. 2015; 40: 1349-1354
        • 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
        • Vanhove W.
        • De Vil J.
        • Van Seymortier P.
        • Boone B.
        • Verdonk R.
        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
        • 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
        • 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
        • Williams J.B.
        • Weiner H.
        • Tyser A.R.
        Long-term outcome and secondary operations after proximal row carpectomy or four-corner arthrodesis.
        J Wrist Surg. 2018; 7: 51-56
        • Kazmers N.H.
        • Stephens A.R.
        • Presson A.P.
        • Xu Y.
        • Feller R.J.
        • Tyser A.R.
        Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis.
        J Wrist Surg. 2019; 8: 66-71