Proximal row carpectomy with partial capitate resection

Twelve patients who had undergone proximal row carpectomy with partial resection of the capitate were reviewed. Ten patients had degenerative arthritis secondary to scapholunate advanced collapse deformity or chronic scaphoid nonunion. Seven of these patients had significant lunocapitate and three had radiolunate degenerative disease. An additional two patients underwent an immediate modified proximal carpectomy for acute complex radiocarpal trauma. At follow-up evaluation after a mean of 55 months, seven patients reported no pain and four patients had only occasional pain with strenuous activity. There was a trend toward increase of the total active flexion/extension arc, from 80 degrees before to 94 degrees after operation. The improvement in flexion from 38 degrees to 46 degrees was significant (p = .01). In the final four patients, who also had interposition of the dorsal capsule, however, the final are of motion averaged 111 degrees. Grip strength improved from 19 to 26 kg following surgery. This strength gain was statistically significant (p = .01 by paired t-test analysis). The favorable results of this partial capitate resection technique may be due to a broader distribution of radiocarpal compression forces. Interposition of the thickened dorsal capsule may also contribute to an improved radiocarpal interface. The intermediate-term results of this review would suggest that lunocapitate and radiolunate disease need not contraindicate a modified proximal row carpectomy.