Proximal Row Carpectomy Impormasyon Pahintulot

Bakit iminungkahi ang operasyong ito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay nagsisimula sa mga opsyon na hindi gaanong invasive na angkop sa iyong kondisyon. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa iyong appointment, kumukuha kami ng history, sinusuri ang iyong pulso, at nagsasaayos ng imaging kung kinakailangan upang malaman kung ano ang problema.

Ang proximal row carpectomy ay nag-aalis ng hanay ng tatlong maliliit na buto ng pulso na pinakamalapit sa iyong forearm. Karaniwan namin itong iminumungkahi kapag ang wear-and-tear arthritis o isang buto na nawalan ng supply ng dugo (Kienböck disease) ay nakapinsala sa mga butong iyon at ang ibang mga gamutan ay hindi nagbigay sa iyo ng sapat na ginhawa. Pagbabago sa aktibidad, physiotherapy o hand therapy, at splinting ang unang ginagawa para sa mga pangmatagalang problema. Para sa ilang acute injuries, ang operasyon ay maaaring ang tamang pagpipilian agad.

Pinapanatili ng operasyon ang paggalaw ng iyong pulso sa halip na patigasin ito. Layunin nito na maibsan ang sakit at hayaan kang gamitin ang iyong pulso para sa mga pang-araw-araw na gawain. Sa maingat na pagpili, kabilang ang mga taong gumagawa ng mabibigat na trabaho gamit ang kanilang mga kamay, ang mga resulta ay nananatili sa loob ng maraming taon. Pag-uusapan natin kung ito ay angkop sa iyo at magdedesisyon tayo nang magkasama.

Bago ang operasyon

Plalanong ng iyong surgeon ang operasyon gamit ang mga scan ng iyong pulso, gaya ng X-ray o MRI, na nagpapakita ng mga buto at cartilage nang detalyado. Sa araw na ito, kailangan mong huminto sa pagkain at pag-inom pitong oras bago ang operasyon. Humihingi kami ng pitong oras sa halip na anim upang maaari kang mauna kung maagang matapos ang listahan sa theatre. Sasabihin sa iyo ng iyong surgeon kung alin sa iyong mga nakasanayang gamot ang lalaktawan at alin ang dapat inumin. Magdala ng nakasulat na listahan ng lahat ng iyong iniinom. Mag-ayos ng taong maghahatid sa iyo pauwi pagkatapos, at magsuot ng maluwag at komportableng damit na may mga manggas na madaling isuot at hubarin. Kung mayroon kang iba pang kondisyong medikal, maaaring kailanganin mo ng mga blood test o pagsusuri kasama ang anaesthetist.

Sa araw ng operasyon

Darating kayo sa surgical admissions unit ng ospital, kung saan kayo ay i-che-check in at ihahanda para sa theatre. Pagkatapos ay makikipagkita kayo sa anaesthetist. Ang operasyong ito ay ginagawa sa ilalim ng general anaesthetic. Minsan ay nagdaragdag ng regional nerve block para sa pagpapaginhawa ng sakit pagkatapos ng operasyon; tatalakayin ito ng anaesthetist sa inyo sa araw na iyon. Pagkatapos ay dadalhin kayo sa operating theatre, kung saan isasagawa ang operasyon.

Magigising kayo sa recovery area, kung saan babantayan kayo ng mga nurse habang nawawala ang bisa ng anaesthetic. Kapag stable na kayo, maaaring pumunta kayo sa ward o uuwi na, depende sa procedure at sa inyong paggaling.

Ano ang kinapapalooban ng operasyon

Ang iyong siruhano ay gagawa ng isang hiwa sa likod ng iyong pulso. Sa pamamagitan ng hiwang ito, tatanggalin nila ang hanay ng tatlong maliliit na buto sa pulso na pinakamalapit sa iyong forearm. Ang mga susunod na buto, ang bilog na dulo ng isang buto at ang katugmang socket nito sa iyong forearm, ay hahayaang manatili sa pwesto. Ang mga surface na ito ay may malusog na cartilage, ang madulas na gliding tissue na nagpapahintulot sa mga joint na gumalaw nang walang sakit. Maingat na susuriin ng iyong siruhano ang cartilage na ito habang isinasagawa ang operasyon, dahil ito ang pagdidulasan ng pulso pagkatapos.

May isang istruktura na napakahalaga: isang matibay na strap ng tissue sa bahagi ng palad ng pulso na tumutulong upang panatilihing matatag ang mga natitirang buto. Sinisiguro ng iyong siruhano na mapanatili ito, dahil sinusuportahan nito ang paggalaw ng pulso kapag wala na ang mga damaged na buto.

Ang layunin ay isang mas simpleng pulso. Sa halip na tatlong hanay ng maliliit na buto na nagkikiskisan sa mga gasgas na surface, mayroon ka nang isang madulas na joint na gumagawa ng trabaho. Walang metal o plastik na ilalagay, at walang buto na itatali ng wire o ituturnilyo, kaya walang kailangang tanggalin sa huli.

Ang hiwa ay sasara gamit ang mga tahi. Lalagyan ito ng dressing sa ibabaw, at pananatilihin mo ang dressing na iyon sa loob ng humigit-kumulang 10 araw.

Dahil walang mga buto na kailangang magdugtong, ang iyong pulso ay hindi kailangang panatilihing hindi gumagalaw sa isang cast pagkatapos. Maaari nang simulan ang paggalaw ng iyong kamay nang maaga, na isa sa mga dahilan kung bakit ang operasyong ito ay angkop para sa mga taong nais na patuloy na gamitin ang kanilang pulso.

Tatalakayin ng iyong siruhano sa iyo ang plano bago ang araw ng operasyon, at maaari kang magtanong sa anumang oras bago isagawa ang operasyon.

Pagkatapos ng operasyon

Magigising ka sa recovery area, pagkatapos ay ililipat ka sa ward kapag stable ka na. Karamihan sa mga pasyente ay nananatili ng isang gabi sa ospital pagkatapos ng operasyong ito, bagaman ang ilan ay nakakauwi sa mismong araw. Ang pain relief ay ibinibigay ayon sa iyong pangangailangan, at regular kang susuriin ng mga nurse. Ang iyong pulso ay babalutin ng isang soft dressing. Minsan ay gumagamit ng sling o half plaster sa harap ng iyong forearm, at minsan ay hindi; sasabihin sa iyo kung ano ang naaangkop sa iyo bago ka umalis. Dahil walang mga butong kailangang magdugtong, maaaring simulan nang maaga ang paggalaw ng iyong kamay. Hinahayaan naming nakalagay ang dressing sa loob ng humigit-kumulang 10 araw; mangyaring huwag itong tanggalin bago ang panahong iyon maliban kung sinabi namin sa iyo. Papalitan o tatanggalin namin ito kapag nakita ka namin. Dapat may kasama ka sa unang 24 oras pagkauwi mo sa bahay.

Paggaling

Ang paggaling mula sa operasyong ito ay madalas na mas mabilis kaysa sa inaasahan ng mga tao. Dahil walang mga butong kailangang magdugtong, ang iyong pulso ay hindi pinapanatiling matigas sa isang cast. Maaari nang simulan ang paggalaw ng iyong kamay nang maaga, at ang banayad na paggalaw ay karaniwang hinihikayat mula sa mga unang araw.

Asahan ang ilang sakit at pamamaga sa paligid ng likod ng iyong pulso sa simula. Unti-unti itong huhupa habang lumilipas ang mga linggo. Nakatutulong ang pagpapanatiling nakataas ng iyong kamay kapag ikaw ay nagpapahinga, at ang pag-inom ng iyong pain relief ayon sa nireseta ay nagpapanatili sa iyong komportable habang nababawasan ang hapdi. May ilang tao na nakapapansin na mas malala ang pamamaga sa mga umaga at bumubuti habang ginagamit ang kamay sa loob ng araw.

Ang iyong rehabilitasyon ay kasama si Ruby Doolan, ang aming hand therapist sa Extend Rehabilitation. Gagabayan niya ang iyong mga ehersisyo at gagawa ng anumang splint na kailangan mo, karaniwan ay sa loob ng humigit-kumulang isang linggo pagkatapos ng operasyon. Sa simula, magtatrabaho ka sa banayad na pagbaluktot at pagtuwid ng pulso at mga daliri. Habang bumabalik ang paggalaw at humuhupa ang pamamaga, ang mga ehersisyo ay unti-unting dadagdagan patungo sa paghawak (gripping), pagbuhat, at paggamit ng iyong kamay para sa mga pang-araw-araw na gawain tulad ng pagbibihis, pagkain, at pagsusulat. Kapag kaya mo nang humawak nang walang sakit, maaari nang ibalik ang mga mas mabibigat na gawain.

Ang pagmamaneho ay hindi dapat madaliin. Kailangan mong wala nang anumang sling o splint, kayang hawakan ang manibela gamit ang dalawang kamay at makatugon sa isang emergency stop, at wala nang iniinom na matatapang na pain medication. Tingnan ang aming gabay sa driving after upper-limb surgery para sa buong detalye.

Ang bawat tao ay gumagaling sa sarili nilang bilis, kaya maaaring magkaiba ang iyong timeline. Gagabayan ka ng iyong surgeon at ng iyong hand therapist sa buong proseso.

Ano ang maaaring maging problema

Karamihan sa mga pasyente ay gumagaling nang maayos, ngunit paminsan-minsan ay maaaring magkaroon ng mga problema. Binabantayan kayo nang maigi ng inyong surgeon at ng team upang maagapan ang anumang isyu.

Ang ilang mga pulso ay nagkakaroon ng mas malalang wear-and-tear arthritis sa paglipas ng mga taon pagkatapos ng operasyong ito. Maaari kayong makaramdam ng pananakit o paggagaralgal (grinding) na dahan-dahang bumabalik, o ang pakiramdam na mas naninigas ang pulso kaysa dati. Kung mangyari ito, banggitin ito sa inyong susunod na review upang masuri ito gamit ang mga bagong scan.

Kakaunting tao ang nangangailangan ng mas malaking operasyon sa huli, kung saan ang buong pulso ay pinapatigas sa pamamagitan ng pagsasama-sama ng mga natitirang buto. Karaniwan itong nangyayari dahil bumalik ang sakit at ang ibang mga gamutan ay hindi sapat na nakatulong. Kung ang sakit ng inyong pulso ay patuloy na lumalala sa halip na bumuti, sabihan ang inyong surgeon, na magpapaliwanag sa inyo ng mga opsyon.

Dahil ang operasyong ito ay nagtatanggal ng buto sa halip na pagdugtungin ang mga buto, ang mga karaniwang panganib ng hindi paghihilom o hindi pagsasama ng mga buto (bones failing to join) ay hindi naaangkop dito. Wala ring naiwang metal o plastik sa pulso, kaya hindi na kailangan ng karagdagang operasyon upang tanggalin ang hardware.

Kung mapansin ninyo ang isang malalim at pumupulsong sakit (throbbing pain) na hindi nawawala sa simpleng painkiller, o pamamaga at pamumula na kumakalat mula sa sugat, makipag-ugnayan agad sa klinika. Ang mga senyales na ito ay kailangang masuri agad sa halip na maghintay sa inyong susunod na appointment.

Ang ilang mga tao ay nananatiling may pananakit ng pulso, o napapansing hindi na sila makabalik sa trabaho o mga aktibidad na ginagawa nila noon. Kung ang sakit o panghihina ay patuloy na naglilimita sa inyo matapos ang recovery, banggitin ito sa inyong review. Ang inyong surgeon at hand therapist ay maaaring tumingin kung ano pa ang maaaring makatulong, mula sa karagdagang therapy hanggang sa iba pang mga gamutan.

Ang table ng mga komplikasyon sa pahinang ito ay naglilista ng mga tipikal na rate kung nais ninyo ang mga detalye.

Kailan dapat tumawag sa amin

Tumawag sa amin kung kayo ay may lagnat, o kung ang pamumula, pamamaga, o paglabas ng likido mula sa sugat ay lumalala. Tumawag sa amin kung mayroon kayong malalim at tumitibok na sakit na hindi naibabawas ng mga simpleng painkiller. Pumunta sa emergency kung mayroon kayong biglaang matinding sakit, pamamaga o sakit sa binti (calf), o kahirapan sa paghinga. Pumunta sa emergency kung mawalan kayo ng pakiramdam sa inyong kamay o hindi maigalaw ang inyong mga daliri o pulso. Ang mga senyales na ito ay kailangang masuri agad.

Saan maaaring magbasa nang higit pa tungkol sa kondisyon

Ang pahinang ito ay tungkol sa operasyon mismo. Ang kondisyong ginagamot nito, kabilang ang kung ano ang ipinapakita ng ebidensya tungkol sa kung kailan nakatutulong ang operasyon at kung kailan hindi, ay tinalakay nang mas detalyado sa pahinang SLAC and SNAC Wrist.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

At long-term followup, all patients older than thirty-five years of age at the time of proximal row carpectomy maintained a satisfactory range of motion, grip strength, and pain relief and were satisfied with the result [1].
Proximal row carpectomy with interposition arthroplasty is an effective motion-sparing procedure for patients with proximal capitate and/or lunate fossa arthritis, improving pain and function [6].
Short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo proximal row carpectomy and meniscus interposition arthroplasty are comparable with those receiving proximal row carpectomy alone [7].

Anatomy & Pathophysiology

Bony Anatomy

The wrist includes the distal radioulnar, radiocarpal, and ulnocarpal joints and the eight carpal bones and their proximal and distal articulations and attached ligaments [23].
The proximal row of carpal bones consists of the scaphoid, lunate, triquetrum, and pisiform [23].
The distal row of carpal bones consists of the trapezium, trapezoid, capitate, and hamate [23].
The capitate is the largest carpal bone [23].
The pisiform and trapezoid are the smallest carpal bones [23].
The capitate articulates with seven other bones [23].
The pisiform articulates with one other bone, the triquetrum [23].
The radiocarpal joints are formed by the articulation of the distal radius with the scaphoid and lunate through their respective concave facets on the distal radius and the triquetrum on the triangular fibrocartilage [23].
The distal concave articular surfaces of the proximal carpal row form the midcarpal articulations with the distal row [23].
The distal radius has three articular components: the scaphoid fossa, the lunate fossa, and the sigmoid notch [27].
The scaphoid and lunate fossae allow articulation with the scaphoid and lunate bones, respectively [27].
The sigmoid notch allows articulation with the ulna medially [27].
A ridge between the scaphoid and lunate fossa corresponds with the scapholunate interval [27].
The concave elliptical distal radius is oriented in the sagittal plane with an average of 11 degrees of volar tilt [27].
In the frontal plane, the average radial inclination of the distal radius is 23 degrees [27].
Radial length, measured from the tip of the radial styloid to the ulnar articular surface, averages 13 mm [27].
The distal ulnar convexity articulates at the lesser sigmoid notch of the distal radius [23].
The sigmoid notch articular surface accommodates the ulnar head through two thirds of its arc [23].
There is about a 20-degree inclination of the distal ulna at its articulation with the radius [23].

Ligaments

Extrinsic carpal ligaments connect the radius or the ulna to the carpus [28].
In general, volar ligaments are stronger than dorsal ligaments [28].
The radioscaphocapitate ligament connects to the waist of the scaphoid, around which the scaphoid rotates, and limits ulnar translation of the carpus [28].
The long radiolunate ligament helps to limit ulnar translocation of the carpus [28].
The short radiolunate ligament helps control lunate position [28].
The radioscapholunate ligament is a vascular conduit, not a true ligament, also known as the ligament of Testut [28].
The ulnocapitate ligament attaches to the ulnar head and originates from the volar margin of the ulnar fovea [28].
The ulnocapitate ligament is the most superficial or palmar of the palmar ulnocarpal ligaments [28].
The dorsal radiocarpal ligament has a trapezoidal shape and passes from the dorsal rim of the distal radius to the lunate and the triquetrum [28].
Fibers of the dorsal radiocarpal ligament insert onto the dorsal lunotriquetral interosseous ligament [28].
The scapholunate interosseous ligament is a major stabilizer of the wrist and the most commonly injured wrist ligament [28].
The scapholunate interosseous ligament is C-shaped, consisting of dorsal, palmar, and interosseous portions, with the dorsal portion being the strongest and thickest [28].
The scapholunate interosseous ligament provides a flexion force on the lunate given its attachment to the scaphoid [28].
The lunotriquetral interosseous ligament is C-shaped, where the volar portion is the thickest and strongest [28].
The lunotriquetral interosseous ligament provides an extension moment on the lunate given its attachment to the triquetrum [28].
The capitohamate ligament is a thick ligament, 5 × 5 mm in cross section, with extensions to the third or fourth metacarpals [28].
The dorsal intercarpal ligament passes from the dorsal tubercle of the triquetrum to the distal pole of the scaphoid [28].
The dorsal intercarpal ligament reinforces the elastic dorsal wrist capsule and helps stabilize the scapholunate articulation with a contribution to the dorsal scapholunate interosseous ligament from its deep fibers [28].
The space of Poirier is an area adjacent to the proximal capitate without ligamentous attachment, situated ulnar to the radioscaphocapitate ligament and radial to the long radiolunate in the floor of the carpal tunnel [28].
The space of Poirier is a weak area that is vulnerable to instability [28].
The distal carpal row separates from the lunate through the space of Poirier during a perilunate dislocation [28].
The triangular fibrocartilage complex includes the ulnar collateral ligament, the dorsal and volar radioulnar ligaments, the articular disc, the meniscal homologue, the extensor carpi ulnaris sheath, and the ulnolunate and ulnotriquetral ligament [23].
The triangular fibrocartilage attaches to the base of the ulnar styloid and separates the hyaline cartilage–covered ulnar head from the styloid [23].

Biomechanics and Kinematics

The wrist joint’s motion planes include flexion, extension, radial deviation, ulnar deviation, and circumduction [28].
There is minimal carpal motion with pronosupination [28].
Approximately 62° of wrist extension occurs through the radiocarpal joint [28].
62% of wrist flexion occurs through the midcarpal joint [28].
The midcarpal joint is mostly responsible for 20° and 40° of radial and ulnar deviation, respectively [28].
The midcarpal joint is responsible for the “dart thrower’s motion,” which involves moving from radial extension into ulnar flexion positioning of the wrist [28].
The radius bears 80% of the axial load transmitted through the radiocarpal joint in neutral ulnar variance [28].
The ulna bears 20% of the axial load transmitted through the radiocarpal joint in neutral ulnar variance [28].
The proximal row of carpal bones forms an intercalated segment between the distal carpal row and the distal radius and is bound into a functional unit by the scapholunate interosseous ligament and lunotriquetral interosseous ligament [28].
The distal row is rigid, with little motion between its bones due to stout intercarpal ligaments, and acts as a functional unit with the scaphoid bridging both rows [28].
During wrist flexion from neutral, the distal row flexes and ulnarly deviates slightly while the scaphoid also pronates [28].
During wrist flexion from neutral, the proximal row flexes differentially, with more rotation through the scaphoid, followed by the triquetrum and the lunate [28].
The proximal row translates dorsally during wrist flexion [28].
During wrist extension from neutral, the distal row extends and radially deviates slightly while the scaphoid also supinates [28].
During wrist extension from neutral, the proximal row extends differentially, with more motion in the scaphoid, followed by the triquetrum and then the lunate [28].
The proximal row translates palmarly during wrist extension [28].
Hysteresis can be quantified using 4DCT wrist kinematics and is greater in wrists with scapholunate ligament injury than in healthy wrists [31].
A normative range of median radiolunate interosseous proximities during wrist motion has been quantified [20].

Classification

Triquetro-lunate fusions are the commonest type of fusions in the carpal region [22].

Clinical Presentation

In patients with continued pain over the radial side of the carpus, attention should be given to the other carpal bones and the distal radius and not just the scaphoid [14].
Os styloideum must be suspected in patients with persistent pain in the dorsal aspect of the hand or wrist [33].

Investigations

Imaging Modalities

MRI is the modality of choice for imaging radiographically occult fractures of the hand and wrist [29].
The primary advantages of MRI compared with CT and radiography are improved tissue characterization, especially of soft tissues such as ligamentous structures in the wrist and synovium in the hand, and the lack of ionizing radiation [29].
Modern MRI is generally at 1.5T or 3T, with 3T being much preferred for hand and wrist imaging, especially for imaging small fields of view [29].
7T MRI has recently become approved for clinical use and has the potential to become a powerful tool for hand and wrist imaging as applications are developed [29].
MRI with contrast enhancement is most commonly used to determine whether soft-tissue lesions are solid or cystic or, in the case of rheumatologic imaging, to better visualize erosions and synovial burden [29].
Dynamic contrast enhancement has been used with inconsistent results to assess for the presence of avascular necrosis in the lunate or scaphoid after injury [29].
MR arthrography can be performed for evaluation of the triangular fibrocartilage and intercarpal ligament tears, but this is generally unnecessary with the increasing availability of high field MRI [29].

Arthroscopy

To be successful with wrist arthroscopy and mitigate iatrogenic injury, a clear understanding of the topographical and 3-dimensional spatial anatomic relationships in the wrist as well as a patient’s unique anatomic variances is critical [12].
A good experience in wrist arthroscopy is necessary for the realization of arthroscopic radioscapholunate fusion [8].
In a comparative study of needle arthroscopy versus conventional arthroscopy, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between the two groups [17].

Treatment

At long-term followup, all patients older than thirty-five years of age at the time of proximal row carpectomy maintained satisfactory range of motion, grip strength, and pain relief and were satisfied with the result [1].
Regardless of the construct used, if the distal radius articular surface is well reduced and other principles of fracture fixation are applied, most patients treated with a dorsal spanning plate can expect to regain functional wrist range of motion [2].
The use of a wrist fixator allows open wound care and permits free access to the wrist for early secondary operations [10].
No complications occurred due to the arm and elbow supports or fingertraps in the context of horizontal fingertrap traction in distal radial fractures [9].

Complications

Postoperatively, extension of the fingers remained poor for over 3 months following an unusual carpometacarpal fracture-dislocation [4].
No complications occurred due to arm and elbow supports or fingertraps during horizontal fingertrap traction in distal radial fractures [9].

Recovery

At long-term follow-up, all patients older than thirty-five years of age at the time of proximal row carpectomy maintained a satisfactory range of motion [1].
At long-term follow-up, all patients older than thirty-five years of age at the time of proximal row carpectomy maintained satisfactory grip strength [1].
At long-term follow-up, all patients older than thirty-five years of age at the time of proximal row carpectomy maintained satisfactory pain relief [1].
At long-term follow-up, all patients older than thirty-five years of age at the time of proximal row carpectomy were satisfied with the result [1].
Proximal row carpectomy with interposition arthroplasty improves pain in patients with proximal capitate and/or lunate fossa arthritis [6].
Proximal row carpectomy with interposition arthroplasty improves function in patients with proximal capitate and/or lunate fossa arthritis [6].
Short- to mid-term outcomes for patients with end-stage wrist arthritis affecting the capitate who undergo proximal row carpectomy and meniscus interposition arthroplasty are comparable with those receiving proximal row carpectomy alone [7].
Postoperatively, recovery of the wrist was rapid in a case of unusual carpometacarpal fracture-dislocation [4].
In a case of unusual carpometacarpal fracture-dislocation, extension of the fingers remained poor for over 3 months postoperatively [4].

Key Evidence

[L4] At the time of long-term followup, all patients older than thirty-five years of age at the time of a proximal row carpectomy had maintained a satisfactory range of motion, grip strength, and pain relief and were satisfied with the result. [1] (10.2106/jbjs.e.00261)
[L4] Regardless of the construct used, if the distal radius articular surface is well reduced and other principles of fracture fixation are applied, most patients treated with a DSP can expect to regain functional wrist ROM. [2] (10.1177/15589447241247335)
[L5] Postoperatively recovery of the wrist was rapid, though extension of the fingers remained poor for over 3 months. [4] (10.1016/0020-1383(94)90161-9)
[L4] Proximal row carpectomy with interposition arthroplasty is an effective motion-sparing procedure for patients with proximal capitate and/or lunate fossa arthritis, improving pain and function. [6] (10.1177/15589447241298721)
[L3] Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone. [7] (10.1177/15589447241262052)
[L5] The authors present their technique and tips for performing this arthroscopic intervention, noting that a good experience in wrist arthroscopy is necessary for its realization. [8] (10.1016/j.eats.2022.02.015)
[L4] No complications occurred due to the arm and elbow supports or fingertraps. [9] (10.1016/s0020-1383(99)00161-8)
[L4] The use of a wrist fixator allows open wound care and permits free access to the wrist for early secondary operations. [10] (10.1016/s0020-1383(99)00267-3)
[L5] To be successful with wrist arthroscopy and mitigate iatrogenic injury, a clear understanding of the topographical and 3-dimensional spatial anatomic relationships in the wrist as well as a patient’s unique anatomic variances is critical. [12] (10.1016/j.eats.2024.103223)
[L4] In patients with continued pain over the radial side of the carpus, attention should be given to the other carpal bones and the distal radius and not just the scaphoid. [14] (10.1016/0020-1383(95)00081-j)
[L2] In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. [17] (10.1177/15589447241265982)
[Paper] This study quantifies a normative range of median radiolunate interosseous proximities during wrist motion. [20] (10.1177/15589447251352124)
[L5] Triquetro-lunate fusions are the commonest type of fusions in the carpal region. [22] (10.1016/0020-1383(95)00192-1)
[L3] This study demonstrated that hysteresis can be quantified using 4DCT wrist kinematics and is greater in wrists with scapholunate ligament injury than in healthy wrists. [31] (10.1177/17531934261468199)
[L4] Os Styloideum is an infrequent pathology and must be suspected in patients with persistent pain in the dorsal aspect of the hand or wrist. [33] (10.1177/15589447251317232)

References

[1] Proximal Row Carpectomy. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.e.00261

[2] What to Expect? Use of Supplemental Fixation With a Concomitant Dorsal Spanning Plate for Complex Intraarticular Distal Radius Fractures. HAND. 2024. DOI: 10.1177/15589447241247335

[4] An unusual carpometacarpal fracture—dislocation. Injury. 1994. DOI: 10.1016/0020-1383(94)90161-9

[6] Outcomes of Proximal Row Carpectomy With Interposition Arthroplasty for Advanced Wrist Arthritis. HAND. 2024. DOI: 10.1177/15589447241298721

[7] Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study. HAND. 2024. DOI: 10.1177/15589447241262052

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