Plast Reconstr Surg. 2025 May 5. doi: 10.1097/PRS.0000000000012178. Online ahead of print.
ABSTRACT
BACKGROUND: In Kienböck disease with carpal collapse, salvage procedures such as scaphocapitate fusion (SCF) and proximal row carpectomy (PRC) are mainstays of surgical treatment. This study analyzes objective (relative grip and range of motion) and patient-reported outcomes after SCF or PRC in laborers versus non-laborers.
METHODS: A retrospective cohort study of patients who underwent surgery for Kienböck disease within a single health system from 1976 to 2023 was conducted. Postoperative DASH and PRWE scores were surveyed from the available population. Labor status, grip, range of motion, and return to the operating room were collected in the medical record and radiographs were analyzed. Categorical comparisons were performed using Fisher’s exact test or Chi-square testing as deemed appropriate by count. Analysis of variance (ANOVA) was used for comparisons of continuous variables. An alpha of 0.05 was used for all statistical tests. Pairwise student t-testing was performed within groups for comparisons of continuous variables. Statistical analysis was performed in R (version 4.4.1) with an alpha of 0.05.
RESULTS: Sixty-four patients underwent PRC and 78 underwent SCF. Patients with PRC were significantly older than patients with SCF. Mean follow up was 29 (SD=53) months. There was no significant difference in post-operative range of motion or relative grip strength between the cohort groups. Laborers who underwent SCF demonstrated the least disability on DASH scores. There was no significant difference in postoperative DASH scores in PRC when comparing laborers versus non-laborers. In contrast, the DASH and PRWE scores of patients who underwent SCF postoperatively varied between laborers and non-laborers [mean (SD) 11.1 (13.9) vs. 30.5 (24.8) p=0.005 and 17.5 (19.4) vs. 42.3 (31.4) p=0.024]. Patients who underwent SCF had a greater rate of revision surgery compared to PRC (22/78 vs. 6/64, p=0.026). Wrist fusion rates were 19% for SCF compared to 1.6% for PRC (0.0007).
CONCLUSIONS: SCF and PRC demonstrated no difference in postoperative range of motion and grip based on labor status. Laborers with SCF had the least post-operative disability on DASH; however, SCF was associated with the need for additional surgical intervention and conversion to total wrist arthrodesis, likely due to the development of radiocarpal arthritis. Shared decision making remains paramount in discussion of the surgical treatment of Kienböck disease associated with carpal collapse.
PMID:40327820 | DOI:10.1097/PRS.0000000000012178
