Devenir à long terme de la résection de la première rangée du carpe. À propos d’une série de 62 cas

Abstract

Background Arthritic disease of the proximal carpal row may arise as a consequence of fracture, ligament disruption, or Kienbock's disease. A number of investigations advocating partial arthrodesis have renewed concerns about wrist durability following proximal row carpectomy. We aim to determine and analyze functional and radiographic results after proximal row carpectomy. Hypothesis We hypothesized that this surgery could restore a mobile and functional wrist in case of a radio-carpal osteoarthritis or severe carpal trauma. Material and method Sixty-two patients had undergone proximal row carpectomy. The indication for surgery was a radio-carpal osteoarthritis (11 scaphoid nonunion advanced collapse, 24 scapholunate advanced collapse, 3 Kienbock and 6 others) or severe carpal trauma (18 cases). Clinical evaluation (pain, mobility, strength, functional scores) and radiographic were performed for each patient. Results At follow-up, evaluation after a mean of 11.8 years, 15 patients (24.2%) required revision surgery for total wrist arthrodesis in a median of 22 months (6–179) following disabling pain and lack of strength. The failure was statistically correlated to the status of young and manual laborer. The functional result is statistically correlated to pain and low to strength. However, there is no correlation between functional outcome and residual mobility of the wrist. The mobility of the operated wrist is 61.5% and strength is 70% compared to the contralateral healthy side. Conclusion This study confirms the role and long-term efficacy of proximal row carpectomy in the treatment of wrist osteoarthritis and severe carpal trauma. It is a reliable procedure in the long term with a low risk of complications for patients wishing to preserve the mobility of the wrist. In case of failure, common in young patients and manuals laborers, a total wrist arthrodesis remains an effective salvage procedure giving in this series good results.