Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review.

A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.

Long-term follow-up of the three-ligament tenodesis for scapholunate ligament lesions: 9-year results.

We report on a retrospective cohort of 50 cases of three-ligament tenodesis for scapholunate instability. Fifteen cases (30% of our cohort) needed salvage surgery (11 proximal row carpectomies, 2 partial and 2 total wrist fusions) at an average of 33 months and are considered "failures". Of the 35 remaining cases ("success"), 16 (32% of our cohort) were reviewed at average 111 months and had good functional outcomes (QuickDASH 18/100, PRWE 11/100, pain 1/10, satisfaction 9/10). Return to work was 81% and grip strength was 80% of the opposite side. Radiological review found no significant correction in the short-term: scapholunate angle (SLA) from 72° to 69° (p = 0.544), scapholunate distance (SLD) from 3.4 mm to 3.4 mm (p = 0.833) and radiolunate angle (RLA) from 17° to 13° (p = 0.253). A significant deterioration in SLA from 72° to 80° (p = 0.014), not correlated to function, was seen at final follow-up. Radiographic progression to wrist degeneration was seen in 63% of successful cases. In failed cases, we noticed inferior radiographic parameters in the short-term: SLD of 4.6 mm in failed versus 3.4 mm in successful cases (p = 0.038) and RLA of 22° in failed versus 13° in successful cases (p = 0.046). Complication rate was 10% (2 scaphoid necroses, 1 septic arthritis and 2 complex regional pain syndromes). Despite radiological deterioration of SLA and development of degeneration in most cases, three-ligament tenodesis can give satisfactory wrist function in some patients, but we observed a significant number of failures and a high complication rate. LEVEL OF EVIDENCE: IV.

Reliability and reproducibility of Kienbock's disease staging.

We evaluated the interobserver reliability and intraobserver reproducibility of the Lichtman et al. classification for Kienböck's disease by getting four observers with different experience to look at 70 sets of wrist radiographs at different points in time. These observers staged each set of radiographs. Paired comparisons of the observations identified an agreement in 63% of cases and a mean weighted kappa coefficient of 0.64 confirming interobserver reliability. The stage of the involved lunate was reproduced in 78% of the observations with a mean weighted kappa coefficient of 0.81 showing intraobserver reproducibility. This classification for Kienböck's disease has good reliability and reproducibility.