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Proximal row carpectomy

Proximal row carpectomy is for the treatment for SLAC or SNAC wrist arthritis. It is an operation for significant wrist pain. Instead of making the wrist totally stiff as one would do with a total wrist fusion by performing a proximal row carpectomy this enables some range of movement. It is likely that the operation will leave 50% of normal wrist range of movement. It does rely on the integrity of the cartilage on part of the surface of the end of the distal radius (which is the long bone on the thumb side of the forearm) and this operation is therefore quite often preceded by a wrist arthroscopy to ascertain this information. The procedure involves removing the scaphoid, lunate and the triquetrum and this means the capitate bone articulates with the radius.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

The proximal row of carpal bones involves the scaphoid, the lunate and the triquetrium which are removed through an incision through the back of the wrist. It is longitudinal and about 10cm long. The skin is opened, subcutaneous tissue dissected through; the tendons that extend or straighten the fingers are identified and avoided. There is a small nerve on the back of the hand, which supplies the wrist which is called the dorsal interosseous nerve. This nerve is often transected purposefully during the procedure. The wrist joint is then opened and the three proximal carpal bones (scaphoid, lunate and triquetrum) are excised. The scaphoid is probably the most difficult one to remove from the back of the wrist as it has quite strong ligamentous attachments on the front of the wrist and it is removed piece meal. The other two bones are somewhat easier to extract. The wound is closed in layers and the skin is closed with nylon sutures.

POST OPERATIVELY

There is a half cast applied and the hand is elevated over night and the patient is given antibiotics as a prophylactic against infection. The patient goes home in a high arm sling and seen at two weeks for removal of the half plaster and removal of stitches and the wrist is then mobilised with physiotherapy.

COMPLICATIONS

  1. Infection - this is 1 - 2%
  2. Restricted range of movement. Generally the operation results in 50% loss of range of movement but it may be more.
  3. Bad reaction to surgery. This occurs in between 1% and 5% of cases. This is called complex regional pain syndrome, or complex regional pain syndrome type 1 or algodystrophy