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Long Term Outcomes of Proximal Row Carpectomy- A Systematic Review
Harvey Chim, MD1, Steven L. Moran, MD, MPH2
1Department of Plastic Surgery, Case Western Reserve University, Cleveland, OH, 2Division of Hand Surgery, Mayo Clinic, Rochester, MN

Purpose: Selection of patients and long-term durability of proximal row carpectomy is a matter of controversy. Hence, we conducted a systematic review of the English literature to provide best evidence on long-term outcomes following proximal row carpectomy.

Methods: A MEDLINE search using “proximal row carpectomy was performed. 192 studies were identified. All studies with 10 or more years of follow-up were included in the review. Data extracted included patient demographics, indications for surgery, previous surgery, outcome assessment and information on complications and failures.

Results: 147 patients from six studies met the inclusion criteria and were included in the study. The majority of patients were male and involved in occupations that required manual labor. There was no significant difference between preoperative and postoperative flexion/ extension arc and radial/ ulnar deviation, while weighted mean of the postoperative grip strength was 68.4% compared to the contralateral side. DASH, PRWE and Mayo wrist scores compared favorably to those reported for four-corner arthrodesis. There were 21 failures (14.3%) requiring re-operation, evenly distributed among patients with Kienbock’s disease, SNAC and SLAC wrist.

Conclusions: This systematic review confirms the long-term durability of proximal row carpectomy for treatment of degenerative conditions of the wrist. Poorer long-term outcomes are likely to result in patients engaged in heavy manual labor, while better outcomes may be obtained in patients undergoing proximal row carpectomy for trauma or earlier stage Kienbock’s disease.

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