Review Question - QID 217853

A proximal row carpectomy (PRC) procedure should be avoided if there are capitate head degenerative changes.

Scaphoid Nonunion Advanced Collapse (SNAC) describes the specific pattern of progressive arthritis of the wrist that results from a chronic scaphoid nonunion. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing scaphoid fracture nonunion with advanced arthritis of the radioscaphoid joint. Treatment involves observation in the early stages of the disease. A variety of operative procedures may be indicated depending on the severity of the disease and the patient's symptoms.

Shah et al. reviewed SLAC and SNAC injuries of the wrist. They reported that these injuries are the two most common patterns of posttraumatic wrist arthritis. They concluded that PRC is a reasonable treatment option for stage II and III SNAC, with potential disadvantages being a reduction of wrist motion and grip strength. They also state that this procedure should be avoided if there are capitate head degenerative changes.

Weiss et al. reviewed osteoarthritis of the wrist. They reported that this condition may result from a non-united or malunited fracture of the scaphoid or avascular necrosis of the carpus. They concluded that abnormal joint loading produces a spectrum of symptoms, from mild swelling to considerable pain and limitations of motion as the involved joints degenerate.

Figure A is the unlabeled carpal bones of the wrist. Illustration A is the labeled carpal bones of the wrist. Illustration B is a postoperative radiograph of a PRC.

Incorrect Answers:
Answer 1, 2, 3, & 5: A PRC procedure should be avoided if there are capitate head degenerative changes, as evidenced by arthritis between the capitate and lunate. This procedure’s success is reliant upon normal cartilage/joint articulation of the capitate and lunate fossa of the distal radius.