Wrist Replantation with Proximal Row Carpectomy

Journal of the Korean Society for Surgery of the Hand 2006;11(1):36-42.
Published online March 1, 2006.

Hyun-Min Han, Gi-Jun Lee, Kyung-Chul Kim, Sung-Han Ha, Joo-Sung Kim, Sang-Hyun Woo

근위 수근열 절제술을 이용한 완관절부 절단상의 재접합술

한현민, 이기준, 김경철, 하성한, 김주성, 우상현

Abstract

Introduction: The purpose of this study is to introduce operative technique and postoperative results of the hand replantation with proximal row carpectomy in cases of amputation around the wrist joint. Materials and Methods: From May 2003 to April 2005, there were five patients who had complete amputation of the hand by industrial injuries. Amputation level was radio-carpal joint in 3 cases and mid-carpal joint in 2 cases. Three cases were guillotine type and two cases were local crushing type. All were men and the mean age was 26.6 years. The mean follow-up period was 16.8 months. In replantation procedure, wrist joint was stabilized with transarticular fixation with 3 or 4 Kirschner’s wires after proximal row carpectomy. Postoperatively, functional results such as muscle strength, range of motion of the wrist and fingers, and sensory recovery were assessed according to the Chen's criteria. Joint width and arthritic changes of the radiocapitate joint were evaluated with radiologic tools. Results: According to Chen’s criteria, the overall results in five cases were classified as grade II. (Intrinsic muscle power of hands was found to be (grade 4). The mean grip and pinch powers were 38.2% and 41.4% respectively as compared to contralateral hands. The mean arc of flexion-extension of wrist was 45 degrees. Total active motion of fingers was 215 degrees. Static 2-point discrimination of fingertip was averaged 10~15 mm. On the follow-up computerized tomography showed well preserved radio-capitate joint cartilage without any arthritic findings. Conclusion: While performing hand replantation after amputation at the radiocarpal or midcarpal level, proximal row carpectomy is a useful procedure to preserve joint motion of the wrist in selected cases.