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Proximal Row Carpectomy vs Four Corner Fusion for Scapholunate (Slac) or Scaphoid Nonunion Advanced Collapse (Snac) Wrists: A Systematic Review of Outcomes

From the Prince of Wales Hospital, Orthopaedic Department, Randwick, NSW, Australia, the Sunnybrook and Women’s Hospital, Orthopaedic Department, Toronto, Ontario, Canada, and the University Hospital Pellenberg, Katholieke Universiteit Leuven, Department of Orthopaedic Surgery, Pellenberg, Belgium

Correspondence: Jonathan S. Mulford, Suite 29, Prince of Wales Private Hospital, Barker Street, Randwick, 2031, NSW, Australia. E-mail:jonathanmulford{at}hotmail.com.

Proximal row carpectomy (PRC) and scaphoid excision with four-corner fusion (4CF) are common motion-preserving, salvage procedures for the treatment of wrists with scaphoid nonunion (SNAC) or scapholunate advanced collapse (SLAC). A systematic review was undertaken to clarify controversies regarding which of these procedures has the better outcome. We collated 52 articles that examine outcomes for SNAC or SLAC patients undergoing PRC or 4CF. Although the lack of unbiased trials must be acknowledged, this systematic review confirms that both procedures give improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists. PRC may provide better postoperative range of movement and lacks the potential complications specific to 4CF (nonunion, hardware issues and dorsal impingement). However, the risk of subsequent osteoarthritis is significantly higher in PRC patients despite the majority being asymptomatic at the time of review. Grip strength, pain relief and subjective outcomes are similar in both treatment groups.

Key Words: systematic review • proximal row carpectomy • four-corner fusion • scapholunate advanced collapse • scaphoid nonunion advanced collapse • outcome

Journal of Hand Surgery (European Volume), Vol. 34, No. 2, 256-263 (2009)
DOI: 10.1177/1753193408100954


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