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J Hand Surg Am. 2013 May;38(5):893-8. doi: 10.1016/j.jhsa.2013.01.033. Epub 2013 Mar 23.

4-corner arthrodesis and proximal row carpectomy: a biomechanical comparison of wrist motion and tendon forces.

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  • 1Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.

Abstract

PURPOSE:

Controversy exists as to whether a proximal row carpectomy (PRC) is a better procedure than scaphoid excision with 4-corner arthrodesis for preserving motion in the painful posttraumatic arthritic wrist. The purpose of this study was to determine how the kinematics and tendon forces of the wrist are altered after PRC and 4-corner arthrodesis.

METHODS:

We tested 6 fresh cadaver forearms for the extremes of wrist motion and then used a wrist simulator to move them through 4 cyclic dynamic wrist motions, during which time we continuously recorded the tendon forces. We repeated the extremes of wrist motion measurements and the dynamic motions after scaphoid excision with 4-corner arthrodesis, and then again after PRC. We analyzed extremes of wrist motion and the peak tendon forces required for each dynamic motion using a repeated measures analysis of variance.

RESULTS:

Wrist extremes of motion significantly decreased after both the PRC and 4-corner arthrodesis compared with the intact wrist. Wrist flexion decreased on average 13° after 4-corner arthrodesis and 12° after PRC. Extension decreased 20° after 4-corner arthrodesis and 12° after PRC. Four-corner arthrodesis significantly decreased wrist ulnar deviation from the intact wrist. Four-corner arthrodesis allowed more radial deviation but less ulnar deviation than the PRC. The average peak tendon force was significantly greater after 4-corner arthrodesis than after PRC for the extensor carpi ulnaris during wrist flexion-extension, circumduction, and dart throw motions. The peak forces were significantly greater after 4-corner arthrodesis than in the intact wrist for the extensor carpi ulnaris during the dart throw motion and for the flexor carpi ulnaris during the circumduction motion. The peak extensor carpi radialis brevis force after PRC was significantly less than in the intact wrist.

CONCLUSIONS:

The measured wrist extremes of motion decreased after both 4-corner arthrodesis and PRC. Larger peak tendon forces were required to achieve identical wrist motions with the 4-corner arthrodesis compared with the intact wrist. We observed smaller forces for the PRC.

CLINICAL RELEVANCE:

These results may help explain why PRC shows early clinical improvement, yet may lead to degenerative arthritis.

Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

PMID:
23528428
[PubMed - indexed for MEDLINE]
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