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 accessOne-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 SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Post-traumatic carpal collapse. Follow-up and therapeutic concept [in German].Unfallchirurg. 2000; 103: 260-266
- Surgical treatment of scapholunate advanced collapse.J Hand Surg Am. 1994; 19: 751-759
- The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.J Hand Surg Am. 1984; 9: 358-365
- Evolution of arthritis of the wrist.Clin Orthop Relat Res. 1986; 202: 57-67
- 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
- Proximal row carpectomy and intercarpal arthrodesis for the management of wrist arthritis.J Am Acad Orthop Surg. 2003; 11: 277-281
- Effectiveness of four-corner arthrodesis with use of a locked dorsal circular plate.Clin Orthop Relat Res. 2012; 470: 2764-2770
- 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
- Palmar midcarpal instability: the results of treatment with 4-corner arthrodesis.J Hand Surg Am. 2004; 29: 258-263
- Results of a method of 4-corner arthrodesis using headless compression screws.J Hand Surg Am. 2012; 37: 486-492
- 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
- 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
- Clinical evaluation of proximal row carpectomy revealed by follow-up for 10-29 years.Int Orthop. 2009; 33: 1315-1321
- Long-term outcomes of proximal row carpectomy: a series of 62 cases.Hand Surg Rehabil. 2017; 36: 355-362
- Long-term outcomes of proximal row carpectomy: a minimum of 15-year follow-up.Hand (N Y). 2012; 7: 72-78
- 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
- Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis.J Hand Surg Am. 2001; 26: 94-104
- 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
- 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
- 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
- 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
- Proximal Row carpectomy and 4-corner arthrodesis in patients younger than age 45 years.J Hand Surg Am. 2017; 42: 428-435
- Long-term outcome and secondary operations after proximal row carpectomy or four-corner arthrodesis.J Wrist Surg. 2018; 7: 51-56
- Comparison of direct surgical costs for proximal row carpectomy and four-corner arthrodesis.J Wrist Surg. 2019; 8: 66-71
Article Info
Publication History
Published online: February 20, 2020
Accepted:
December 31,
2019
Received:
January 4,
2019
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
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
