Devenir à long terme de la résection de la première rangée du carpe — à propos d’une série de 30 jeunes cas

Proximal row carpectomy is a popular procedure for the treatment of wrist arthritis+ however, the long-term clinical outcomes of this procedure are not well-characterized. We aim to determine long-term results after proximal row carpectomy in a group of 30 young patients. A retrospective study was performed on thirty young patients who underwent proximal row carpectomy during from 2008 to 2012. Medical records and radiographs were reviewed. Clinical evaluation was done using the DASH and the PRWE scores. The contralateral extremity was used as a control. Average age at the time of surgery was 41 years [30–50 years]. Average follow-up was 32 months. On final follow-up, wrist motion and grip strength were not significantly different from preoperative values. Radiographic follow-up beyond 2 years revealed joint narrowing and arthritic changes within the radiocapitate joint. Fifty-two percent of patients were not satisfied with the results of their surgery due to persistent pain or inability to return to previous occupational activities. 30% patients required daily pain medication for wrist pain. Fifty-two percent were able to keep doing the previous manual labor. In our study, wrist motion and grip strength has improved but a high rate of patient dissatisfaction was noted in comparison to previous reports. The patient's DASH scores are comparable to other shorter or longer term outcome studies. The presence of radiocapitate arthritis has not been found to be directly correlated with outcome+. Within this study and the literature, we found that the etiology of the patient's wrist arthritis did not significantly affect final functional outcome scores, also that patients who underwent a posterior interosseous nerve neurectomy performed better on PRWE and DASH scores than those who did not. The reason for poor patient satisfaction within this study may be related to the younger age of our patients, their functional expectations and the functional requirements of their manual labors. In our series, patients preferred to manage wrist pain with medical means or they were unwilling to undergo a complete wrist fusion procedure to treat persistent wrist pain following PRC. Proximal row carpectomy is a reliable procedure in the long term with a low risk of complications for patients with wrist osteoarthritis wishing to preserve the mobility of the wrist. In case of failure, common in young patients and manuals laborers, a total wrist arthrodesis remains maybe salvage procedure.