Abstract
Background Some surgeons advocate for concomitant proximal row carpectomy (PRC) with total wrist
arthrodesis (TWA), though there are limited data to support or oppose this view.
Questions/Purposes Does concomitant PRC improve rates of union, revision, hardware loosening, hardware
failure, and hardware removal in TWA?
Patients and Methods A retrospective cohort study of patients who underwent TWA with and without concomitant
PRC between January 2008 and December 2018 was undertaken. Patients were included
if they underwent TWA using a dorsal spanning plate. Patients were excluded if they
underwent partial wrist arthrodesis, revision TWA, or TWA with nondorsal spanning
plate fixation.
Results A total of 183 wrists in 180 patients were included in the study, 96 (52.5%) in the
TWA only and 87 (47.5%) in the TWA + PRC groups. Median clinical and radiographic
follow-up was 18.0 months (3.0–133.0 months) in the TWA + PRC group and 18.5 months
(2.0–126.0 months) in the TWA only group (p = 0.907). No difference in nonunion (TWA + PRC: 13/87 [14.9%], TWA only: 18/96 [18.8%],
odds ratio: 0.76, p = 0.494), revision (TWA + PRC: 5/87 [5.75%], TWA only: 8/96 [8.33%], hazard ratio
[HR]: 0.73, p = 0.586), loosening (TWA + PRC: 4/87 [4.60%], TWA only: 6/96 [6.25%], HR: 0.74, p = 0.646), failure (TWA + PRC: 5/87 [5.75%], TWA only: 4/96 [4.17%], HR: 1.55, p = 0.530), and removal (TWA + PRC: 12/87 [13.8%], TWA only: 16/96 [16.7%], HR: 0.84,
p = 0.634) were identified.
Conclusion Concomitant PRC might not improve rates of union or diminish complications in patient
undergoing TWA. The role of PRC and the rationale for its use in TWA need to be individualized
and discussed with patients prior to surgery.
Level of Evidence This is a Level IV, therapeutic study.
Keywords
wrist arthrodesis - proximal row carpectomy - dorsal plate
