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A Comparison of Proximal Row Carpectomy and 4. Corner Fusion in Patients Under 45. Years Old
Eric Wagner, MD; Kapil Mehrotra, MD; J.D. Werthel, MD; Bassem T. Elhassan, MD; Steven L. Moran, MD
Mayo Clinic, Rochester, MN

Purpose: The purpose of this study was to examine the long-term survival-free of fusion, complications, and extremity function in patients under 45 who underwent either PRC or 4CF.
Methods: Review of 91 patients who underwent either 4CF (n=49) or PRC (n=42) under the age of 45 years from 1972 to 2008 for the diagnosis of wrist arthritis. Comparing 4CF and PRC groups, there was similar mean age (34 vs 32), but fewer laborers (47% vs 59%) and more males (92% vs 57%) in the 4CF than the PRC group. A similar percentage of patients in 4CF and PRC groups underwent AIN and/or PIN (35% vs 29%, p=0.72).
Results: The mean follow up was 15 years (2-41), including 12 years in the 4CF group and 18 years in the PRC group. There were 11 wrists that required revision to radiocarpal fusion (4 in 4CF and 7 in PRC group). Additional reoperations in the 4CF group included 4 revision 4CF for nonunion, 4 surgeries for impingement, while in the PRC group 1 patient was converted to a wrist arthroplasty, 1 ulnar head replacement, and 1 irrigation and debridement. The 10 and 20-year survival free of fusion rates for the 4CF and PRC were 92% and 88% versus 98% and 90%, respectively. The 10 and 20-year survival free of any revision surgery for the 4CF and PRC were 92% and 88% versus 98% and 90%, respectively (p=0.42). There was no difference in the number of patients reporting moderate or severe pain between PRC and 4CF groups (p=0.19). The mean flexion-extension arc was 53o after 4CF compared to 69o in PRC (p=0.01). Patients who underwent 4CF had slightly improved grip strength (65% of opposite side) compared to PRC (53%) (p=0.07). The mean postoperative DASH scores were 30 vs 20 (PRC vs 4CF) (p<0.001) and PRWE scores were 26 vs 30 (PRC vs 4CF) (p=0.20). Comparing radiographic arthritis, 63% of the PRC and 44% of the 4CF had signs of arthritis, including 40% PRC and 30% 4CF having moderate/severe arthritis (p=0.06).
Summary Points: Both 4CF and PRC represent a good surgical option for young patients with wrist arthritis, with similar survival-free of fusion, complication rates, pain levels, and wrist function. PRC has improved motion, but higher rates of radiocarpal arthritis.

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