Wrist & Hand

Preservation of movement versus pain relief in wrist arthritis

There is always a trade-off in wrist arthritis – a successful wrist fusion will usually eliminate pain at the cost of movement, and in this paper from The Mayo Clinic in Rochester, Minnesota (USA), the discussion of movement-preserving, arthritic-pain-relieving wrist surgical techniques continues.⁹ In recent publications, proximal row carpectomy (PRC) has perhaps started to beat the four-corner fusion (4CF), with reports of lower complication rates and a more physiologic range of movement. In this retrospective review with a mean follow-up of 14 years, the results of 89 young patients who underwent one of the two procedures are reported (51 patients with 4CF, and 38 who underwent PRC). Both techniques were reported to be effective but, as usual, fewer complications were seen in the technically easier PRC, and better eventual movement. Marginally better grip strength was reported in those patients who underwent the 4CF. However, in this long-term follow-up, the revision rates were identical to those of a total wrist fusion. The obvious flaw in this retrospective study is the selection bias (i.e. if there is a concern of mid-carpal as well as radioscaphoid osteoarthritis, we tend to lean towards 4CF rather than PRC). This paper is an impressive long-term follow-up study and the results appear to echo current concepts and practice.