American Association for Hand Surgery

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Proximal Row Carpectomy and 4-Corner Arthrodesis in Patients Younger than 40 Years of Age
Jared J Reid, MD, Trevor D Wolterink, MD, Julia A DeSalvo, B.S, Dane N Daley, MD; Charles A Daly, MD
Medical University of South Carolina, Charleston, SC

Introduction: Proximal row carpectomy (PRC) and four-corner arthrodesis (4CA) are common surgical options aimed at preserving wrist motion, but data comparing outcomes in younger patients is limited. The purpose of this study is to determine if there is a notable difference in outcomes between patients who undergo PRC compared to 4CA in the younger patient (<40 years of age) population.

Methods: A large, retrospective cohort, utilizing the TriNetX Global Collaborative Network database was queried on June 17, 2025, to identify patients aged less than 40 years who underwent either PRC or 4CA procedures. The database was queried using CPT codes. Demographic information was obtained for each cohort. Cohorts were propensity matched to control for demographics and comorbidities. Outcomes assessed included revision surgery, removal of hardware (ROH) procedures and conversion to total wrist arthroplasty. Revision surgery was defined as either total wrist arthrodesis, total wrist arthroplasty, or revision of a failed 4CA. Number of instances and risk differences with associated p-values were calculated within the database.

Results: Prior to matching, the PRC and 4CF cohorts included 601 and 750 patients, respectively. After matching, each cohort included 516 patients. In the matched cohorts, PRC was associated with a lower risk of conversion to wrist arthrodesis compared to 4CF (4.5% vs 6.4%), though this difference was not statistically significant (risk difference -1.9%, p = 0.16). PRC demonstrated a significantly lower risk of revision surgery (1.9% vs 6.6%; risk difference -4.7%, p < 0.0001) and hardware removal (6.6% vs 16.5%; risk difference -9.9%, 95% CI -13.7% to -6.0%, p = 0.0001) compared to 4CF.

Conclusions: Compared to four-corner arthrodesis, proximal row carpectomy in patients under 40 was associated with significantly lower rates of revision surgery and hardware removal. Although the difference in conversion to total wrist arthrodesis was not statistically significant, the overall complication profile favors PRC in this younger population.
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