What is Proximal Row Carpectomy?
Proximal row carpectomy (PRC) is a surgical procedure used to treat certain wrist conditions, especially advanced arthritis or degenerative changes in the wrist. It involves removing the proximal row of carpal bones - specifically the scaphoid, lunate, and triquetrum - to relieve pain and improve function.
What are the Indications for Proximal Row Carpectomy?
PRC is typically performed for:
- Scapholunate advanced collapse (SLAC) wrist
- Scaphoid nonunion advanced collapse (SNAC) wrist
- Post-traumatic wrist arthritis
- Certain chronic wrist injuries or carpal instability
- Patients with good preservation of the capitate and lunate fossa of the radius
What Does the Procedure for Proximal Row Carpectomy Involve?
In general, the procedure for proximal row carpectomy usually takes 1 to 2 hours and involves the following steps:
- The patient is placed under general or regional anesthesia.
- The arm is positioned on an arm table, often with a tourniquet to control bleeding.
- A longitudinal or curved dorsal incision is made on the back of the wrist.
- The extensor tendons are retracted to expose the wrist joint capsule.
- The wrist capsule is incised to expose the proximal row of carpal bones (scaphoid, lunate, and triquetrum).
- The scaphoid, lunate, and triquetrum bones are carefully removed.
- The remaining bones - the distal carpal row and radius - are preserved to maintain partial wrist movement.
- The joint is inspected for smooth articulation between the capitate and the lunate fossa of the radius.
- Any loose debris is removed, and bleeding is controlled.
- The capsule and skin are closed in layers, and a sterile dressing is applied.
What Does Postoperative Care for Proximal Row Carpectomy Involve?
Postoperative care for proximal row carpectomy involves initial wrist immobilization in a splint or cast for about 4 to 6 weeks to allow soft tissue healing. During this period, patients are advised to keep the hand elevated and perform gentle finger movements to reduce swelling and stiffness. Once immobilization is discontinued, a structured physical therapy program begins to restore wrist motion, strength, and function. Activities are gradually increased, with most patients regaining functional use of the wrist within a few months. Pain management, wound care, and monitoring for signs of infection or complications are also essential parts of the recovery process. Regular follow-up visits help track healing progress and address any concerns early.
What are the Risks and Complications of Proximal Row Carpectomy?
Risks and complications of proximal row carpectomy include:
- Persistent or recurrent wrist pain
- Reduced wrist motion or grip strength
- Infection or delayed wound healing
- Nerve injury (causing numbness or tingling)
- Instability or weakness of the wrist
- Development of arthritis at the radiocapitate joint
What are the Benefits of Proximal Row Carpectomy?
Benefits of proximal row carpectomy include:
- Relief from chronic wrist pain
- Preservation of wrist motion (better than wrist fusion)
- Improved hand function and grip strength
- No need for implants or hardware
- Durable results for selected patients with isolated wrist arthritis or bone collapse
It offers a good balance between pain relief and maintaining wrist mobility.
