PRC vs four-corner fusion review

Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes

Mulford JS, Ceulemans LJ, Nam D, et al. The Journal of hand surgery, European volume 2009 · PMID 19369301 · doi:10.1177/1753193408100954

Question

In SLAC or SNAC wrist arthritis, does proximal row carpectomy or four-corner fusion give better outcomes?

Design

Systematic review of published case series reporting outcomes after either procedure.

Patients

Patients with SLAC or SNAC wrist treated with proximal row carpectomy or four-corner fusion.

Intervention

Proximal row carpectomy

Comparison

Four-corner (midcarpal) fusion

Primary outcome

Pain relief, range of movement, grip strength, patient satisfaction, complications and progression to wrist fusion

Key result

Pain relief, grip strength and satisfaction were broadly similar between the two salvage procedures; four-corner fusion had more complications, while proximal row carpectomy carried a higher risk of later radiocapitate arthritis.

Limitations

Based on heterogeneous, mostly retrospective case series with no direct randomised comparison.

Impact on practice

Supports offering either motion-preserving salvage procedure for SLAC/SNAC wrist, with the choice guided by capitate head cartilage status, patient age and demands.