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Proximal Row Carpectomy 25215

synonyms: PRC, proximal row carpectomy

Proximal Row Carpectomy CPT

Proximal Row Carpectomy Indications

  • Disabling wrist pain, secondary to SLAC wrist,
  • Kienbock's disease
  • Scaphoid Nonunion / AVN
  • Acute/Subacute severe carpal fracture/dislocations

Proximal Row Carpectomy Contraindications

  • Severe degenerative changes in the head of the capitate.
  • Rheumatoid arthritis
  • Patients >35y/o are more likely to require revision surgery (fusion).

Proximal Row Carpectomy Alternatives

  • Wrist Arthrodesis
  • Wrist arthroplasty

Proximal Row Carpectomy Planning / Special Considerations

  • Radioscaphocapitate ligament is the prime stabilizer between the capitate and radius after PRC; must ensure it is preserved during surgery.
  • Proximal Row Carpectomy case card.

Proximal Row Carpectomy Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • Supine position. All bony prominences well padded.
  • Examination under anesthesia.
  • Well padded touniquet placed high on the arm.
  • Prep and drape in standard sterile fashion.
  • Exsanginate the arm with Eschmar bandage, inflate tourniquet to 250mmHg.
  • Oblique longitudinal incision centered on radiocarpal joint from ulnar side of radius to the base of 2nd metacarpal.
  • Dissection under 2.5x/3.5x loop magnification
  • Identify extensor retinaculum. Incise longitudinally, opening the 4th extensor compartment. Preserve cuff of retinaculum for later repair.
  • Isolate and retract extensor tendons with penrose drain.
  • Identify PINin floor of the 4th dorsal compartment and transect proximally.
  • Perform T-capsulotomy centered over scapholunate joint.
  • Note dissociation of scapholunate ligament, degenerative changes in radioscaphoid joint etc, Preserved cartilage in capitate.
  • Divide the scaphoid at its waist with in osteotome. Remove the proximal fragment.
  • Excise distal fragment using a threaded Steinmann pin as a joy stick.
  • Verify the integrity of the radioscaphcapitate ligament.
  • Place Steinmann pin in lunate and excise lunate.
  • Place Steinmann pin in triquetrum and excise.
  • If needed radial styloidectomy may be performed with dissection between the 1st and 2nd dorsal compartments. Remove distal 5 to 7mm of radial styloid. Ensure radioscaphocapitate ligament is preserved.
  • Irrigate.
  • Repair capsule to maintain capitate in lunate fossa.
  • Repair extensor retinaculum.
  • Close in layers.

Proximal Row Carpectomy Complications

  • Degenerative changes in the radiocapitate articulation.
  • Stiffness, motion loss.
  • Weakness.
  • CRPS
  • Continued pain.
  • Instability.
  • Degenerative changes in the radiocapitate articulation, Stiffness, motion loss, Weakness, CRPS Continued pain, Instability.

Proximal Row Carpectomy Follow-up care

  • Post-op: Volar splint in neutral, elevation.
  • 7-10 Days: Wound check, short arm cast.
  • 4 Weeks: Cast removed, xray wrist. Start gentle ROM / strengthening exercises. Functional activities. Cock-up wrist splint prn / for light duty work. No heavy manual labor
  • 3 Months:Full activities, may resume manual labor if adequate strength has been achieved.
  • 6 Months:
  • 1Yr: follow-up xrays, assess outcome

Proximal Row Carpectomy Outcomes

  • >10year follow-up: 18% failure requiring fusion at an average of seven years. All in patients < 35y/o at the time of the PRC. Average flexion-extension arc = 72°, average grip strength = 91% of contralateral side. (DiDonna ML, JBJS 2004;86A:2359).

Proximal Row Carpectomy Review References

  • Greens Hand Surgery
  • Van Heest AE, in Masters Techniques: The Wrist, 2002
  • Stern PJ, JBJS 2005;87:166
  • Wyrick JD, JAAOS 2003;11:227

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