Scapholunate Advanced Collapse Wrist: Proximal Row Carpectomy versus Four-Corner Arthrodesis Belgian...
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Transcript of Scapholunate Advanced Collapse Wrist: Proximal Row Carpectomy versus Four-Corner Arthrodesis Belgian...
Scapholunate Advanced Collapse Wrist:
Proximal Row Carpectomyversus
Four-Corner Arthrodesis
Belgian Hand Group 17 november 2007
W. Vanhove MDJ. De Vil MD – P. Vanseymortier MD – M. Mombert MD
Department of Orthopaedic Surgery UGent
Scapholunate Advanced Collapse
Traumatic scapholunate dissociation
Scapholunate Advanced Collapse
Traumatic scapholunate dissociation
Terry Thomas Sign
Scapholunate Advanced Collapse
Traumatic scapholunate dissociation
Rotatory subluxation of scaphoid – Dorsal Intercalated Segment Instability (DISI)
Scapholunate Advanced Collapse
SLAC stage 1
Scapholunate Advanced Collapse
SLAC stage 2
Scapholunate Advanced Collapse
SLAC stage 3
Surgical options
Four-Corner Arthrodesis (SLAC 2-3):
Surgical options
Four–Corner Arthrodesis:
Surgical options
Proximal Row Carpectomy (SLAC 2):
Surgical options
Proximal Row Carpectomy :
Literature (Cohen et al.)
Mobility 4CA 15° more rad dev (P<0,05)
Pain score end F/E worse for PRC
Function VAS = Jebsen: picking up small objects better following PRC
Literature
Surgical options Four-Corner Arthrodesis Proximal Row Carpectomy
Mobility Force
Socio economic impact.
}
Unknown in literature}
No difference
Our Study
Mobility Force Complications Functionality
Economic and insurance issues
General Data
30 patients Surgeon Dr W Vanhove Time of Surgery 1998 → 2004
Four-Corner Arthrodesis 15 Proximal Row Carpectomy 15
General Data
Age: Four-Corner Arthrodesis: 38 y (21-49) Proximal Row Carpectomy: 45 y (29-62)
Follow up
40m
Sex ratio Four-Corner Arthrodesis: 10 ♂ 5 ♀ Proximal Row Carpectomy: 8 ♂ 7 ♀
Preoperative data
Demographics No Significant difference
Mobility No Significant difference
Job related data
Ergos Job Description program
Preoperative physical workload
Ergos Job Description programma
4 CA PRC Total
workload Very light 1 1 2
light 2 4 6
average 8 7 15
Heavy labour
2 2 4
Total 13 14 27
Preoperative data
Demographics No Significant difference
Mobility No Significant difference
Job related data
Workload No Significant difference
Postoperative evaluation:
Mobility Force Complications Functionality Economic and insurance issues
0
5
10
15
20
25
30
35
40
45
50
U/R arc preop U/R arc postop
4CA PRC
Mobility
64
66
68
70
72
74
76
78
80
F/E arc preop F/E arc postop
4CA PRC
U/R deviation arc
F/E arc
Force
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Force 1 Force 2 Force 3 Force 4 Force 5
Four-cornerarthrodesisProximal rowcarpectomy
0
5
10
15
20
25
30
Force 1 Force 2 Force 3 Force 4 Force 5
Four-cornerarthrodesisProximal rowcarpectomy
% of contralateral side Absolute value (KgF)
Position 1 => 5 Position 1 => 5
Literature
Studies comparing 4CA & PRC
4 CA Krakauer J et al (Force)
PRC Wyrick J et al
Tomaino M et al ( mobility)Krakauer J et al (mobility)
4CA=PRC
Cohen M et alTomaino M et al ( Force)
Lucas B et al
Non conclusive
0
2
4
6
8
10
12
14
16
4CA PRC
normal
CTS
Complications
Carpal Tunnel Syndrome
Complications
Carpal Tunnel Syndrome
Theories
4CA bonegraft in carpal tunnel
immobilisation (subclinical CRPS, less nervegliding)
PRC shorter carpal tunnel is less length to compress?
EAROM = nerve gliding
Any suggestions ?
General functional scores
Cooney Score (less is worse) Four-Corner Arthrodesis: 61 Proximal Row Carpectomy: 67
=> No Significant difference
DASH Score (more is worse) Four-Corner Arthrodesis: 22 Proximal Row Carpectomy: 10
=> No Significant Difference
Economic & Insurance issues
Hospital stay physiotherapy Back to Work Postoperative working capacity
Hospitalisation
Days in
hospital
4 CA PRC
0
2
4
6
8
Physiotherapy
Number of
sessions
4 CA PRC
0
20
40
60
80
Time Off Work
weeks
4 CA PRC
0
20
40
60
80
100
Return to work following 4CA
200
13
21
4
8
preop postop
same work
adaptations at work
other work
non active
Return to work following PRC
100
14
101
13
preop postop
same work
adaptations at work
other work
non active
Conclusion
Four-Corner Arthrodesis Proximal Row Carpectomy
ProPhysiological
Short hospital stay
Technically easierEarly mobility
Few complicationsVery short hospital stayFaster to resume work
Few adaptations at work
Contra
Technically demandingImmobilisation
Complications (nonunion, CTS,…)
Slower to resume workMore adaptations at work
Non-physiologicalStage III
No difference Mobility, Force, Function
Conclusion
Four-Corner Arthrodesis Proximal Row Carpectomy
ProPhysiological
Short hospital stay
Technically easierEarly mobility
Few complicationsVery short hospital stayFaster to resume work
Few adaptations at work
Contra
Technically demandingImmobilisation
Complications (nonunion, CTS,…)
Slower to resume workMore adaptations at work
Non-physiologicalStage III
No difference Mobility, Force, Function
Conclusion
Four-Corner Arthrodesis Proximal Row Carpectomy
ProPhysiological
Short hospital stay
Technically easierEarly mobility
Few complicationsVery short hospital stayFaster to resume work
Few adaptations at work
Contra
Technically demandingImmobilisation
Complications (nonunion, CTS,…)
Slower to resume workMore adaptations at work
Non-physiologicalStage III
No difference Mobility, Force, Function
Conclusion
Stage 3 PRC
What have we learned ?
We no longer perform 4CA
What do we do with SLAC 3
wrists in young patients doing heavy labour?
variation of 3CA using shortening capitolunate fusion
(Herbert screw, no bonegraft, 3 weeks casting, preserves original radiolunate joint, avoids ulnocarpal impingement)
W. Vanhove MD
J. Devil MD
P. Vanseymortier MD
M. Mombert MD
Dept. of orthopaedic surgery
University Hospital Gent
Invaliditeit (fys AO) A:
Art. 150 : beperkingen van de bewegingen der radiocarpale en mediocarpale gewrichten
Flexie/Extensie: Radio/ulnaire deviatie
Niet apart Als gelijklopend beschouwd
Tabel III PRC: F/E : 39°/0°/40° = 4 + 2/2 = 5% 4CA: F/E : 45°/0°/31° = 7 + 1/2 = 7.5%
Invaliditeit (fys AO) B:
Art. 150 : Bewegingsbeperking F/E Tabel III
PRC: F/E : 39°/0°/40° = 4 + 2/2 = 5% 4CA: F/E : 45°/0°/31° = 7 + 1/2 = 7.5%
Art. 153 : “Uitgesproken krachtsvermindering” Op basis van amytrofie of EMG
+ 1 à 5%
Art. 154 : Restpijn + 1 à 10%
Art 153 & 154 : niet combineren