gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Article

Send article

Factors Associated with Conversion to Wrist Fusion after Proximal Row Carpectomy or Four Corner Arthrodesis

Meeting Abstract

Search Medline for

  • presenting/speaker Jan Jonas Van Hernen - Massachusetts General Hospital, Boston, United States
  • Jonathan Lans - Massachusetts General Hospital, Boston, United States
  • Neal Chen - Massachusetts General Hospital, Boston, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-321

doi: 10.3205/19ifssh0628, urn:nbn:de:0183-19ifssh06288

Published: February 6, 2020

© 2020 Van Hernen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objectives/Interrogation: This study aimed to investigate the rate of conversion to total wrist fusion (arthrodesis or arthroplasty) in patients that underwent either proximal row carpectomy (PRC) or four-corner arthrodesis (FCA). Additionally, we evaluated the factors associated with conversion to wrist fusion and progression of radiographic arthrosis for patients treated with PRC or FCA.

Methods: We retrospectively identified patients that underwent a PRC or FCA using ICD-9 procedure and CPT codes and verified these by chart review. We included all adult patients (n=266) that were treated at a single institutional system from 2002-2016. The median age was 54 (IQR:45-62) years, and the median follow up was 8.1 (IQR:5.1-11.7) years. Eighty patients underwent FCA, and 186 underwent a PRC. We performed a multivariable logistic regression to evaluate factors associated with wrist fusion, including all explanatory variables with a p<0.10 in bivariate analysis.

Results and Conclusions: There was an increased progression of lunate fossa osteoarthritis in the PRC cohort (20% vs. 2%, p=0.005). The median time to wrist fusion was 16 months (IQR:12.1-37.7) for PRC and 32 months (IQR:19-45) for FCA. Intraoperative posterior and anterior interosseous neurectomy was associated with a lower rate of conversion to wrist fusion (p=0.004) after PRC. Smoking was independently associated with a higher rate of conversion to wrist fusion (OR: 30.9, p=0.017) after FCA.

Although PRC and FCA appear to have similar rates of arthrodesis at mid-term follow-up; PRC appears to demonstrate more radiographic arthritis. A partial denervation of the wrist may delay conversion or lower the rates of conversion to arthrodesis after PRC (Table 1 [Tab. 1], Table 2 [Tab. 2]).