Proximal row carpectomy (PRC) is a surgical technique used in some patients with advanced degenerative change in the wrist. The proximal row of carpal bones are excised, converting the wrist joint into a simple hinge-type radiocarpal articulation. The procedure reduces pain from the joint while still preserving motion.
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Indications
Advanced arthritis from:
- scapholunate advanced collapse (SLAC wrist)
- scaphoid nonunion advanced collapse (SNAC wrist)
- scaphoid non union
- Kienboch disease
- failed lunate arthroplasty
Contraindications
- arthritis of the proximal pole of the lunate or lunate fossa of the distal radius
- post-traumatic articular incongruity in the lunate fossa of radius
Procedure
The procedure is performed via a dorsal approach through the third extensor compartment. The proximal row (that is the scaphoid, lunate and triquetrum) are resected. Following resection, the capitate articulates with the lunate fossa of the distal radius.
Outcomes
Compared to four-corner arthrodesis PRC produces:
- improved active range of movement
- no change in grip strength
- less post operative complications.
Alternative procedures include:
- four-corner fusion
- three-corner fusion