Scaphoid Excision and 4-Bone Arthrodesis Versus Proximal Row Carpectomy: A Comparison of Contact Biomechanics

Purpose We compare scaphoid excision and 4-bone arthrodesis (FBA) with proximal row carpectomy (PRC) in terms of contact pressure, area, and location. Methods Six cadaveric forearms underwent simulated FBA with K-wires. We measured pressures in the radiocarpal joint with Fuji contact film after we applied a 200-N load via the wrist tendons with the wrist in neutral, flexion, and extension. We repeated the experiment after excising the lunate and triquetrum, to create a PRC in the same specimens. Results Contact pressure in the PRC wrist was significantly greater, by 25%, compared with the FBA wrist for all wrist positions. The PRC wrist had a significantly smaller contact area, by 43%, compared with the FBA wrist. In the FBA wrist, lunate contact was more dorsal in flexion but more volar in extension. In the PRC wrist, capitate contact was more dorsal and radial in flexion, whereas the contact was more volar and ulnar in extension. Comparing contact location, FBA contact was significantly more ulnar than PRC contact in wrist flexion. We found no significant difference in contact translation (the distance between the contact locations in the positions of wrist flexion and extension) for the lunate in FBA or the capitate in PRC. Conclusions The FBA wrist has significantly lower contact pressure (P < .001), greater contact area (P < .001), and equal contact translation compared with the PRC wrist. These qualities may make FBA less susceptible to degeneration over time. By advancing our understanding of the biomechanics of both wrist procedures, we may better tailor them to the individual patient. Clinical relevance Current biomechanical evidence is lacking for common motion-preserving procedures for wrist arthritis. Comparing contact pressure, area, and location provides a biomechanical basis of our clinical understanding of these surgeries. (J Hand Surg 2012;37A:1861-1867. Copyright (C) 2012 by the American Society for Surgery of the Hand. All rights reserved.)