Post-traumatic wrist atrhritis: PRC versus 4-corner fusion

Introduction Painful destruction of the wrist as a consequence of scaphoid non-union advanced collapse (SNAC) or chronic advanced scapho-lunate dissociation (SLAC) is a challenge to treat. In the late stages of either condition, only salvage procedures can be discussed. The option of proximal row carpectomy (PRC) only remains available in stage II, when the mid-carpal joint is still preserved and the capitate head has an intact cartilage. Four-corner fusion (4CF) is still possible in stages III of these conditions. While PRC is technically less demanding and does not involve the possibility of nonunion, different postoperative problems have been described with this technique. This includes radial styloid impingement and pisiform bone impingement syndromes, leading to further interventions. In addition progressive osteoarthritis at the lunate fossa has been observed, compromising long-term results. In contrast, 4-corner fusion is a technically demanding procedure with a risk of non-union, despite the introduction of new implants. Furthermore malunion with incomplete lunate repositioning may compromise the clinical results. This study attempts to analyze the results of PRC compared to 4-corner fusion in stages II/III wrists suffering from SNAC or SLAC situations.