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2008 Annual Meeting Abstracts

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Long-Term Outcomes of Proximal Row Carpectomy - 15 year follow-up results
Steven L. Moran, MD, Mir H. Ali, MD. PhD.
Mayo Clinic, Rochester, MN, USA.

PURPOSE: Post-traumatic wrist arthritis continues to be a major problem in hand surgery. Two procedures have been performed over the last twenty years to alleviate pain while trying to preserve some motion at the wrist: proximal row carpectomy and four corner arthrodesis. The long-term clinical and radiographic outcomes of these procedures are not well-characterized. The purpose of this study is to evaluate long-term results with PRC at our institution in an attempt to identify factors that may improve clinical success and patient satisfaction.
METHODS: An Institutional Review Board approved retrospective study review was performed on all patients who underwent proximal row carpectomy between January 1967 and January 1992 as determined by Mayo Clinic surgical list review. All charts were reviewed. Questionnaires including the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient Rated Wrist Exam (PRWE), and hand motion diagrams were sent to all surviving patients. Examination of the contralateral extremity was used as normal controls. Factors associated with a poor outcome or failure were determined using multi-variant analysis and a student t-test. Statistical significance was set at p<0.05.
RESULTS: 81 patients underwent proximal row carpectomy at our institution between 1967 and 1992. Patients’ average age at surgery was 41 years old. The most common indications for surgery were degenerative arthritis (SLD, SLAC), Keinböck’s, or neuromuscular spasticity. 61 patients responded to the questionnaires (75%). On average, wrist flexion decreased 5.7°, wrist extension increased 6.3°, radial deviation increased 0.3°, and ulnar deviation decreased 0.4° (p>0.2). Grip strength did not significantly change relative to the contralateral extremity (52.2% to 48.0%) ). 33% of the patients did not experience adequate pain relief in the operative wrist, continuing to require daily pain medication. 44% of patients were not satisfied with the results of their surgery due to persistent pain, weakness of grip, or inability to return to previous occupational activities. 26% of patients underwent wrist arthrodesis by 15 years and only 2% returned to previous manual labor occupational activities.
CONCLUSION: While proximal row carpectomy has been utilized over the last thirty years as a procedure to decrease wrist pain while preserving wrist motion, our fifteen year follow-up data indicates that most patients continue to complain of persistent pain requiring daily medication and do not report great satisfaction with the outcomes of their wrist surgery. Better alternatives, including four corner arthrodesis and wrist arthrodesis must be explored in order to improve patient pain relief and satisfaction.


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