Intracarpal arthrodesis or proximal row carpectomy in SNAC and SLAC wrist

Abstract

Objective: To clarify the indications for the choice of operative intervention in patients with SLAC and SNAC wrist and to compare the functional results after proximal carpectomy (PRC) and partial intracarpal arthrodesis with scaphoid excision. Methods: A total of 20 patients underwent four corner fusion intracarpal arthrodesis with scaphoid excision, and 8 patients underwent proximal carpectomy in the period from 2016 to 2023. The mean postoperative follow-up period for patients with intracarpal arthrodesis was 3.2 years and for patients with proximal carpectomy was 3.5 years. Results: Regarding range of motion of the wrist in the flexion-extension axis, the proximal carpectomy patients in our series showed better results than the intracarpal arthrodesis patients, an average of 84% in the PRC patients and 75% in the intracarpal arthrodesis patients relative to the contralateral limb. In the patients with intracarpal arthrodesis, however, we recorded a greater preserved range of motion in the radial-ulnar deviation axis of the wrist. Grip strength was measured at 6 months postoperatively and averaged 72% for the PRC group compared with 83% for patients with intracarpal arthrodesis to the contralateral limb. Conclusion: Both proximal carpectomy and intracarpal arthrodesis are surgical interventions that achieve similar functional outcomes for the treatment of degenerative conditions of the wrist (SLAC/SNAC).