Union of Radiocarpal Fusion With and Without Proximal Row Carpectomy: A Systematic Review

Purpose Wrist fusion provides a solution to the painful, arthritic wrist, and can be concomitantly performed with or without a proximal row carpectomy (PRC). The benefits of combining a PRC with fusion include a large amount of local bone graft for fusion and a lower number of joints needed to fuse. We hypothesized that wrist fusion combined with PRC will have a higher fusion rate than wrist fusion performed without PRC. Methods A systematic review was performed to identify all papers involving wrist arthrodesis using the following databases: PubMed, Ovid, Scopus, Web of Science, and COCHRANE. A literature search was performed using the phrases wrist OR radiocarpal and fusion OR arthrodesis. Inclusion criteria included complete radiocarpal fusion performed for rheumatoid, posttraumatic, or primary arthritis; union rates available; English-language study. Studies were excluded if case reports; diagnoses other than the ones listed previously; inability to abstract the data. Data collected included wrist fusions with PRC or without PRC, union rate, patient age, underlying diagnosis, and method of fixation. Results A total of 50 studies were included in the analysis. There were 41 studies with no PRC, 8 studies with PRC, and 1 study with and without PRC. There were 347 patients with a PRC and 339 patients had a successfully fused wrist (97.7%). There were 1,355 patients who had a wrist fusion with no PRC, and1,303 patients had successful wrist fusion (96.2%). The difference in fusion rate between the 2 groups, 97.7% versus 96.2%, was not statistically significant. Conclusions There is no statistically significant difference with regards to union rate in wrist fusion with a PRC versus wrist fusion without a PRC. Copyright (C) 2021 by the American Society for Surgery of the Hand. All rights reserved.

Automated summary

Wrist fusion provides a solution to painful and arthritic wrists, with the additional benefit of combining it with a PRC for potentially higher fusion rates. However, the study results show that the presence or absence of PRC does not significantly impact the union rate of wrist fusion.