proximal row carpectomy

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Capsule open and triquetrum being removed


pre op xrays

C arm photo of flexion

Dorsal incision 

Capsule being opened up

Three proximal carpal bone

Pre op flexion



Dorsal incision line






                                                                                                                                                                     
30 year old male patient come to our clinic with wrist pain and restricted wrist motion. He was referred by a orthopedic colleague. Patient was offered proximal row carpectomy, he had no wrist flexion and around 15 degree wrist extension. Under block anesthesia through dorsal longitudinal incision carpal were exposed ,extensor retinaculum was opened through 3 and 4 compartment . Scaphoid , lunate and triquetrum were removed . A layer of capsule was interposed between proximal pole capitate and lunate fossa of radius. Terminal division  of posterior interoseous nerve is divided resulting in good pain relief. Capitate sits into lunate fossa of radius at end of operation. After surgery a bully dressing is done and slab is applied. Sutures are removed ar two weeks and mobilization of wrist is after  six weeks. Finger movement is encouraged immediately after surgery. Once passive range of motion is achieved then active movement is encouraged. After three months full range of activity is allowed. 
Patient's are encouraged to be in long term follow up and radio capitate space is observed on the basis on amount of narrowing (none , partial or complete loss of space ) to monitor degenerative changes. In a well selected patient's it is a good procedure which preserve joint motion . Patient's in late 30 or 40 are good candidate for this procedure.

            
Proximal row carpectomy is a motion preserving surgical procedure ,it was described by Stemm in 1939. 
Indications ( When it is needed)
Kienbocks Disease
Scapholunate advanced collapse
Scaphoid non unuion advanced collapse
Failed Scaphoid or lunate implants
Chronic perilunate dislocation
Painful degenerated rheumatoid wrist

Contra indications ( when not to do) there is no such contra indications but if cartilage on proximal pole of capitate is not good then it is preferred to do a distal based flap interposition. Between capitate and radius. The results of PRC evaluated for long term follow up of 10 years have shown good results, 89% grip strength as of opposite hand is achieved and range of motion is arround 95 degree. Failure as defined as requiring conversion to an arthrodesis is arround 10 to 18% in various studies.





Dr Adhishwar Sharmma 8860650846 adhishwar7@gmail.com
                       





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