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Motion-Preserving Treatment Options for Wrist Arthritis: Proximal Row Carpectomy Versus CLX Fusion, a Novel Method of Intercarpal Arthrodesis
Praveen G. Murthy, AB; Mark L. Wang, MD; Sidney M. Jacoby, MD; A. Lee Osterman, MD; John M. Bednar, MD
The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA
Introduction: Degenerative arthritis of the wrist due to scapholunate advanced collapse (SLAC) is commonly treated with proximal row carpectomy (PRC) or four-corner arthrodesis with scaphoid excision, both of which are well-established motion-preserving procedures. In this study, we compare proximal row carpectomy with CLX fusion, a novel method of intercarpal arthodesis involving the capitolunate and triquetro-hamate joints, in order to examine the value of CLX fusion relative to PRC as a treatment option for SLAC wrist.
Methods: From 2000-2009, 27 patients with degenerative SLAC wrist arthritis were treated by a single surgeon using CLX fusion. Average age at time of surgery was 55 years and average follow-up was 51 months. Preoperative and postoperative range of motion and grip strength were collected, as were standardized Patient-Rated Wrist Evaluation (PRWE) scores. In the same time period, another single surgeon treated 24 patients with degenerative SLAC wrist arthritis using PRC. Average age at time of surgery was 55 years and average follow-up was 24 months. Corresponding data on PRC outcomes was collected retrospectively and compared with outcomes of CLX fusion.
Results: In CLX patients, grip strength compared to the contralateral wrist increased by 32% postoperatively, and average operative-sided grip strength increased by 27% (p<0.01); in PRC patients, neither grip strength compared to the contralateral wrist nor average operative-sided grip strength increased by a significant margin. In CLX patients, wrist extension and flexion was decreased postoperatively 17% and 25% respectively, yielding a 21% decrease in mean flexion-extension arc (p<0.01); in PRC patients, wrist extension and flexion decreased by 13% and 36% respectively, yielding a 26% decrease in mean flexion-extension arc (p<0.01). There was no significant difference between pre- and postoperative radial/ulnar deviation or mean coronal plane arc in either set of patients. In addition, there was no significant difference between the PRWE pain and functionality scores across the two groups; overall, patients were satisfied with results, with mean pain scores <12/50 and mean functionality scores <18/100 in both groups.
Conclusions: CLX fusion, involving intercarpal arthrodesis of the capitolunate and triquetrohamate joints, offers a suitable motion-preserving treatment option for wrist arthritis, yielding similar results to proximal row carpectomy in terms of postoperative range of motion, pain and functionality. Our data indicates that CLX fusion offers an improvement in grip strength, and further analysis may indicate this procedure as a preferred option in certain cases for treatment of degenerative scapholunate advanced collapse wrist arthritis.
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