Skip to content

Proximal Row Carpectomy

PRC for SLAC/SNAC II and Kienbock: radiocapitate articulation, capitate/lunate-fossa gatekeeping, PRC vs four-corner fusion, capsular interposition, long-term survivorship.

Overview

Proximal row carpectomy is a reliable, motion-preserving salvage procedure that provides pain-free function comparable to total or limited carpal fusions [6]. It is indicated for Lichtman stage IIIA or IIIB Kienböck's disease, with durable results demonstrated at an average follow-up of 10 years [8]. The procedure is suitable for all patients older than thirty-five years, who maintain satisfactory range of motion, grip strength, and pain relief at long-term follow-up [4]. While the mean pivot point shifts proximally by 6.8 to 9.1 mm after the procedure for all tested motions [1], the surgery for static scapholunate dissociation results in a stiffened, weakened wrist [2].

Outcomes vary by comparison and patient demographics. Among patients with SNAC and SLAC wrist conditions, findings favor limited carpal fusion over proximal row carpectomy, except regarding flexion-extension and grip strength in women [10]. Four-corner arthrodesis provides significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side compared to proximal row carpectomy [12], yet proximal row carpectomy results in better wrist flexion, extension, and flexion-extension arc [12]. Proximal row carpectomy is associated with a lower overall complication rate than four-corner arthrodesis [12].

Surgical approach and postoperative management influence recovery. Arthroscopic proximal row carpectomy allows for rapid mobilization compared with the open procedure [5], while a palmar approach facilitates early rehabilitation with better recovery of wrist motility compared to midcarpal tenodesis [3]. Postoperative immobilisation is not necessary after proximal row carpectomy [7]. For patients with contraindications such as pre-existing arthritis in the capitate head or lunate facet of the radius, a lateral meniscal interposition allograft is supported for clinical trial [15].

Anatomy & Pathophysiology

Kinematics and Load Transfer

Proximal row carpectomy (PRC) alters wrist biomechanics by shifting the mean pivot point proximally by 6.8 to 9.1 mm across all tested motions [1]. This procedure results in significant contact translation [24] and modifies load transfer due to the mismatch of the radiocapitate articulation, leading to an overloaded wrist [11]. While PRC does not significantly alter the contact pressures or area of the lunate fossa of the radiocarpal joint [23], it decreases normal wrist flexion and extension [13]. Radial deviation is specifically limited by impingement of the trapezoid on the radial styloid [13].

Comparative Outcomes and Alternatives

The FBA wrist demonstrates significantly lower contact pressure [21] and a greater contact area [21] compared with the PRC wrist, though both exhibit equal contact translation [21]. Lunate excision alone preserves simulated active dart-throwing motion more effectively than PRC [27]. Conversely, performing a PRC for static scapholunate dissociation results in a stiffened and weakened wrist [2]. The shape of the capitate is not a prognostic factor for functional outcome after PRC [26].

Complications and Mitigation

The midcarpal tenodesis procedure shows progressive carpal collapse over time even in the absence of symptoms [3]. Primary radial styloidectomy reduces the risk of radial impingement without affecting clinical function or patient-related outcomes [22].

Classification

Lichtman: Proximal row carpectomy is a reliable and durable procedure for patients with Lichtman stage IIIA or IIIB Kienböck's disease at an average follow-up of 10 years [8].

SNAC/SLAC: Limited carpal fusion is favored over proximal row carpectomy for SNAC and SLAC wrist conditions, except regarding flexion-extension and grip strength in women [10].

Scapholunate Dissociation: Proximal row carpectomy performed for static scapholunate dissociation results in a stiffened and weakened wrist [2].

Acute Fracture-Dislocation: Acute proximal row carpectomy is an option for patients with complex carpal fracture dislocations, particularly those with lunate fracture, concomitant scaphoid fracture and scapholunate ligament injury, or preexisting wrist arthritis [17].

Scaphoid Nonunion: Proximal row carpectomy is a reliable motion-preserving salvage procedure that provides pain-free function comparable to total or limited carpal fusions for scaphoid nonunion [6].

Other Considerations: Age: Patients older than thirty-five years of age at the time of proximal row carpectomy maintained satisfactory range of motion, grip strength, and pain relief at long-term follow-up [4]. Biomechanics: Proximal row carpectomy results in a mean proximal shift of the pivot point of 6.8 to 9.1 mm for all tested motions [1]. The anatomical mismatch of the radiocapitate articulation leads to significant changes in load transfer and wrist overload after proximal row carpectomy [11]. Removal of the proximal carpal row decreases normal wrist flexion and extension [13]. Radial deviation is limited by impingement of the trapezoid on the radial styloid after proximal row carpectomy [13]. Complications: Pisiform bone impingement syndrome is a cause of persistent ulnocarpal pain after proximal row carpectomy [9]. Technique Comparison: The palmar approach for proximal row carpectomy allows early rehabilitation with better recovery of wrist motility compared to midcarpal tenodesis [3]. Midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms [3]. Arthroscopic proximal row carpectomy allows for rapid mobilization of the wrist compared with the open procedure [5]. Postoperative Protocol: Postoperative immobilisation is not necessary after proximal row carpectomy [7].

Clinical Presentation

Proximal row carpectomy (PRC) is indicated for scaphoid nonunion, Lichtman stage IIIA or IIIB Kienböck's disease, and complex carpal fracture dislocations involving lunate or scaphoid fractures with ligamentous injury [6, 8, 17]. Patients older than thirty-five years maintain satisfactory range of motion, grip strength, and pain relief at long-term follow-up [4]. The procedure provides pain-free function comparable to total or limited carpal fusions for scaphoid nonunion [6]. However, among patients treated for SNAC and SLAC wrist conditions, limited carpal fusion is generally favored over PRC, except regarding flexion-extension and grip strength in women [10].

Biomechanical Consequences: The procedure results in a mean proximal shift of the wrist pivot point ranging from 6.8 to 9.1 mm for all tested motions [1]. Removal of the proximal carpal row decreases normal wrist flexion and extension [13]. The anatomical mismatch of the radiocapitate articulation leads to significant changes in load transfer and wrist overload [11]. Radial deviation is specifically limited by impingement of the trapezoid on the radial styloid [13].

Functional Outcomes and Complications: PRC results in better wrist flexion, extension, and flexion-extension arc compared to four-corner arthrodesis, though four-corner arthrodesis provides significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side [12]. PRC is associated with a lower overall complication rate compared to four-corner arthrodesis [12]. While PRC provides good pain relief with preservation of wrist motion [14], it can result in a stiffened and weakened wrist when performed for static scapholunate dissociation [2]. Volar carpus dislocation is a rare complication following PRC for scapholunate advanced collapse; patients developing this may later experience worsening radiocarpal arthritis despite operative reduction and Kirschner wire fixation [28]. Additionally, pisiform bone impingement syndrome is a previously unreported cause of persistent ulnocarpal pain after PRC [9].

Surgical Approach and Rehabilitation: The palmar approach allows for early rehabilitation and better recovery of wrist motility compared to midcarpal tenodesis [3]. Arthroscopic PRC allows for rapid mobilization of the wrist compared with the open procedure [5]. Postoperative immobilisation is not necessary after PRC [7]. Conversely, midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms [3].

Contraindications and Adjuncts: A lateral meniscal interposition allograft is supported for clinical trial in patients with contraindications for PRC, such as pre-existing arthritis in the capitate head or lunate facet of the radius [15]. Radio-scapho-capitate ligament reconstruction can stabilize the wrist despite radio-scapho-capitate ligament insufficiency after PRC [16]. Both PRC and four-corner fusion provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists [19].

Investigations

Plain radiography: Preoperative radiographs often underestimate degenerative changes at the radiolunate joint and do not correlate well with intraoperative findings [29]. Proximal row carpectomy is indicated when there is no capitolunate arthrosis, as the procedure provides satisfactory postoperative wrist range of motion and grip strength with few complications in this setting [18]. The procedure is reliable and durable for patients with Lichtman stage IIIA or IIIB Kienböck's disease at an average follow-up of 10 years [8]. In cases of static scapholunate dissociation, the procedure results in a stiffened and weakened wrist [2].

Other Considerations: The mean pivot point shifts proximally by 6.8 to 9.1 mm after proximal row carpectomy for all motions tested [1]. Removal of the proximal carpal row decreases normal wrist flexion and extension [13], while radial deviation is limited by impingement of the trapezoid on the radial styloid [13]. The mismatch of the radiocapitate articulation leads to significant changes in load transfer, overloading the wrist after proximal row carpectomy [11]. Midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms [3]. Pisiform bone impingement syndrome is a previously unreported cause of persistent ulnocarpal pain after proximal row carpectomy [9].

Prognostic Factors and Outcomes: All patients older than thirty-five years of age at the time of proximal row carpectomy maintained satisfactory range of motion, grip strength, and pain relief at long-term follow-up [4]. Postoperative immobilisation is not necessary after proximal row carpectomy [7]. Arthroscopic proximal row carpectomy allows for rapid mobilization of the wrist compared with the open procedure [5]. Proximal row carpectomy provides pain-free function that compares favorably with total or limited carpal fusions for scaphoid nonunion [6]. Among patients treated for SNAC and SLAC wrist conditions, findings favor Limited Carpal Fusion compared to Proximal Row Carpectomy, except for flexion-extension and grip strength in women [10]. Four-corner arthrodesis provides significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side compared to proximal row carpectomy [12]. Conversely, proximal row carpectomy results in better wrist flexion, extension, and flexion-extension arc compared to four-corner arthrodesis [12], and results in a lower overall complication rate compared to four-corner arthrodesis [12]. Acute proximal row carpectomy is an option for patients with complex carpal fracture dislocations, particularly those with fracture of the lunate, concomitant scaphoid fracture and scapholunate ligament injury, or preexisting wrist arthritis [17]. A lateral meniscal interposition allograft is supported for clinical trial in patients with contraindications for proximal row carpectomy, such as pre-existing arthritis in the capitate head or lunate facet of the radius [15].

Treatment

Operative

Indications: Proximal row carpectomy (PRC) is a reliable motion-preserving salvage procedure for scaphoid nonunion, providing pain-free function that compares favorably with total or limited carpal fusions [6]. It is indicated for Lichtman stage IIIA or IIIB Kienböck's disease, demonstrating reliability and durability at an average follow-up of 10 years [8]. Patients older than thirty-five years of age at the time of surgery maintain satisfactory range of motion, grip strength, and pain relief at long-term follow-up [4]. While findings generally favor limited carpal fusion over PRC for SNAC and SLAC wrist conditions, PRC remains a viable option for preserving flexion-extension and grip strength in women [10]. A lateral meniscal interposition allograft is supported for clinical trial in patients with contraindications for PRC, such as pre-existing arthritis in the capitate head or lunate facet of the radius [15].

Surgical Approach / Technique: PRC can be performed via a palmar approach or arthroscopically. The palmar approach allows for early rehabilitation with better recovery of wrist motility compared to midcarpal tenodesis [3]. Arthroscopic PRC is a safe, effective, and reliable procedure for a variety of wrist conditions and allows for rapid mobilization of the wrist compared with the open procedure [5]. Postoperative immobilisation is not necessary after the procedure [7]. However, PRC performed for static scapholunate dissociation results in a stiffened and weakened wrist [2]. Midcarpal tenodesis, an alternative consideration, shows progressive carpal collapse over time even in the absence of symptoms [3].

Other Considerations: Following PRC, the mean pivot point shifts proximally by 6.8 to 9.1 mm after the procedure for all motions tested [1]. Patients generally experience good pain relief with preservation of wrist motion [14]. A specific complication, pisiform bone impingement syndrome, has been identified as a previously unreported cause of persistent ulnocarpal pain after PRC [9]. In complex salvage scenarios, total wrist arthrodesis combined with proximal row carpectomy provides reliable and reproducible benefits [20].

Complications

Stiffness / Arthrofibrosis: Proximal row carpectomy results in a stiffened and weakened wrist when performed for static scapholunate dissociation [2]. However, midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms, whereas proximal row carpectomy allows early rehabilitation with better recovery of wrist motility [3]. Arthroscopic proximal row carpectomy allows for rapid mobilization of the wrist compared with the open procedure [5]. Postoperative immobilisation is not necessary after proximal row carpectomy [7].

Instability: The mismatch of the radiocapitate articulation leads to significant changes in load transfer, overloading the wrist after a proximal row carpectomy [11].

Other Considerations: Pisiform bone impingement syndrome is a previously unreported cause of persistent ulnocarpal pain after proximal row carpectomy [9]. Four-corner arthrodesis provides significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side compared to proximal row carpectomy [12]. Proximal row carpectomy results in better wrist flexion, extension, and flexion-extension arc compared to four-corner arthrodesis [12]. Proximal row carpectomy is associated with a lower overall complication rate compared to four-corner arthrodesis [12].

Recovery

Light activity (weeks): Postoperative immobilisation is not necessary after proximal row carpectomy, facilitating immediate mobilization [7]. The palmar approach allows for early rehabilitation with better recovery of wrist motility compared to other techniques [3], while arthroscopic proximal row carpectomy specifically enables rapid mobilization of the wrist compared with the open procedure [5].

Full activity (months): Proximal row carpectomy is a reliable motion-preserving salvage procedure that provides pain-free function comparable to total or limited carpal fusions [6]. Patients experience good pain relief with preservation of wrist motion following the procedure [14]. However, the procedure results in a stiffened and weakened wrist when performed for static scapholunate dissociation [2].

Complete recovery / outcome plateau (months): Long-term follow-up indicates that patients older than thirty-five years of age maintain satisfactory range of motion, grip strength, and pain relief [4]. These patients also report satisfaction with the result at long-term follow-up [4]. The procedure is reliable and durable for patients with Lichtman stage IIIA or IIIB Kienböck's disease at an average follow-up of 10 years [8].

Rehabilitation protocol: The palmar approach for proximal row carpectomy allows early rehabilitation with better recovery of wrist motility [3]. Arthroscopic proximal row carpectomy allows for rapid mobilization of the wrist compared with the open procedure [5]. Postoperative immobilisation is not necessary after proximal row carpectomy [7].

Functional milestones: Proximal row carpectomy resulted in better wrist flexion, extension, and flexion-extension arc compared to four-corner arthrodesis [12]. Conversely, four-corner arthrodesis provided significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side compared to proximal row carpectomy [12]. The mean pivot point shifted proximally by 6.8 to 9.1 mm after proximal row carpectomy for all motions tested [1].

Other Considerations: Midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms [3]. Proximal row carpectomy resulted in a lower overall complication rate compared to four-corner arthrodesis [12]. Pisiform bone impingement syndrome is a previously unreported cause of persistent ulnocarpal pain after proximal row carpectomy [9]. Radio-scapho-capitate ligament reconstruction allows for stabilization of the wrist despite radio-scapho-capitate ligament insufficiency after proximal row carpectomy [16].

Key Evidence

  • [Paper] The mean pivot point shifted proximally (6.8-9.1 mm) after proximal row carpectomy for all motions tested. (10.1016/j.clinbiomech.2011.03.002)
  • [L4] Proximal row carpectomy, when performed for static scapholunate dissociation, results in a stiffened, weakened wrist. (10.1177/1753193410382719)
  • [L4] The proximal row carpectomy by palmar approach allows early rehabilitation with better recovery of wrist motility, while the midcarpal tenodesis shows progressive carpal collapse over time even in the absence of symptoms. (10.1177/1753193418775067)
  • [L4] At the time of long-term follow-up, all patients older than thirty-five years of age at the time of a proximal row carpectomy had maintained a satisfactory range of motion, grip strength, and pain relief and were satisfied with the result. (10.2106/00004623-200411000-00001)
  • [L4] Arthroscopic proximal row carpectomy appears to be a safe, effective, and reliable procedure for a variety of wrist conditions, and it allows for rapid mobilization of the wrist compared with the open procedure. (10.1016/j.jhsa.2011.01.009)
  • [L4] Proximal row carpectomy has proven to be a reliable motion-preserving salvage procedure that can provide pain-free function that compares favorably with total or limited carpal fusions. (10.1016/s0749-0712(21)01450-5)
  • [L3] The authors conclude that postoperative immobilisation is not necessary after proximal row carpectomy. (10.1177/1753193408092490)
  • [L4] At an average follow-up of 10 years, proximal row carpectomy is a reliable and durable procedure for patients with Lichtman stage IIIA or IIIB Kienböck's disease. (10.1016/j.jhsa.2008.02.031)
  • [L4] Pisiform bone impingement syndrome is a previously unreported cause of persistent ulnocarpal pain after proximal row carpectomy. (10.1007/s00402-014-2002-z)
  • [L3] Among patients treated for SNAC and SLAC wrist conditions, findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy, except for flexion-extension and grip strength in women. (10.1186/s13018-023-04177-7)
  • [L5] The study confirmed that the mismatch of the radiocapitate articulation led to significant changes in load transfer, with the wrist being overloaded after a proximal row carpectomy due to the anatomical mismatch of the radiocapitate articulation. (10.1177/1753193409344527)
  • [L1] Four-corner arthrodesis provided significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side, while proximal row carpectomy resulted in better wrist flexion, extension, and flexion-extension arc, along with a lower overall complication rate. (10.1177/1753193414554359)
  • [L5] Removal of the proximal carpal row decreased normal wrist flexion and extension, with radial deviation limited by impingement of the trapezoid on the radial styloid. (10.1016/j.jhsa.2006.10.014)
  • [L3] Patients experienced good pain relief with preservation of wrist motion. (10.1177/1753193415597096)
  • [L5] These results support the clinical trial of a lateral meniscal interposition allograft in patients with contraindications for proximal row carpectomy, such as pre-existing arthritis in the capitate head or lunate facet of the radius. (10.1016/j.jhsa.2008.10.030)
  • [L4] With the RSCL reconstruction, it was possible to stabilize the wrist despite the RSCL insufficiency after PRC. (10.1177/1753193417752319)
  • [L5] Acute proximal row carpectomy is an option for some patients with complex carpal fracture dislocations, particularly those with fracture of the lunate, concomitant scaphoid fracture and scapholunate ligament injury, or preexisting wrist arthritis. (10.1007/s12593-014-0162-2)
  • [L5] PRC provides satisfactory postoperative wrist range of motion and grip strength with few complications, especially when there is no capitolunate arthrosis. (10.1016/j.hcl.2012.08.022)
  • [L4] Both procedures provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists. (10.1177/1753193408100954)
  • [Paper] Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. (10.1016/j.otsr.2015.09.032)
  • [L5] The FBA wrist has significantly lower contact pressure, greater contact area, and equal contact translation compared with the PRC wrist. (10.1016/j.jhsa.2012.05.040)
  • [L4] Primary radial styloidectomy reduced the risk of radial impingement without affecting clinical function or patient-related outcomes. (10.1177/17531934221087588)
  • [L5] In contrast to prior studies that demonstrated significant increases in contact pressure and decreases in contact area after PRC, our findings propose that performing a PRC does not significantly alter the contact pressures or area of the lunate fossa of the radiocarpal joint. (10.1177/15589447221105542)
  • [L5] There is significant contact translation after PRC, which provides quantitative support of the theory that translational motion of the PRC may explain its good clinical outcomes. (10.1016/j.jhsa.2008.12.004)
  • [L3] The shape of the capitate was not a prognostic factor for functional outcome after PRC. (10.1016/j.jhsa.2015.02.019)
  • [L5] Lunate excision alone preserved simulated active dart-throwing motion more effectively than PRC. (10.1016/j.jhsg.2026.101029)
  • [L5] The complication was successfully managed with operative reduction and Kirschner wire fixation, though the patient later developed worsening radiocarpal arthritis. (10.1016/j.jhsg.2020.04.007)
  • [L4] Preoperative radiographs did not correlate well with intraoperative findings, often underestimating degenerative changes at the radiolunate joint. (10.1016/j.jhsa.2014.03.032)

See Also

References

[1] Effects of proximal row carpectomy on wrist biomechanics: A cadaveric study. Clinical Biomechanics. 2011. DOI: 10.1016/j.clinbiomech.2011.03.002

[2] Proximal row carpectomy for scapholunate dissociation. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410382719

[3] Proximal row carpectomy, scaphoidectomy with midcarpal arthrodesis or midcarpal tenodesis: when and how to use. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418775067

[4] Proximal Row Carpectomy: Study with a Minimum of Ten Years of Follow-up. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00001

[5] Arthroscopic Proximal Row Carpectomy. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.01.009

[6] PROXIMAL ROW CARPECTOMY FOR THE TREATMENT OF SCAPHOID NONUNION. Hand Clinics. 2001. DOI: 10.1016/s0749-0712(21)01450-5

[7] Proximal Row Carpectomy With or Without Postoperative Immobilisation. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408092490

[8] Proximal Row Carpectomy for Advanced Kienböck's Disease: Average 10-Year Follow-Up. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.031

[9] Two cases of pisiform bone impingement syndrome after proximal row carpectomy. Archives of Orthopaedic and Trauma Surgery. 2014. DOI: 10.1007/s00402-014-2002-z

[10] Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04177-7

[11] Biomechanics of the wrist after proximal row carpectomy in cadavers. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409344527

[12] Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554359

[13] Carpal Kinematics After Proximal Row Carpectomy. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2006.10.014

[14] Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415597096

[15] Proximal Row Carpectomy: Role of a Radiocarpal Interposition Lateral Meniscal Allograft. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.10.030

[16] Radio-scapho-capitate ligament reconstruction during proximal row carpectomy. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193417752319

[17] Acute Proximal Row Carpectomy after Complex Carpal Fracture Dislocation. Journal of Hand and Microsurgery. 2015. DOI: 10.1007/s12593-014-0162-2

[18] Proximal Row Carpectomy. Hand Clinics. 2013. DOI: 10.1016/j.hcl.2012.08.022

[19] Proximal Row Carpectomy vs Four Corner Fusion for Scapholunate (Slac) or Scaphoid Nonunion Advanced Collapse (Snac) Wrists: A Systematic Review of Outcomes. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408100954

[20] Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. Orthopaedics & Traumatology: Surgery & Research. 2015. DOI: 10.1016/j.otsr.2015.09.032

[21] Scaphoid Excision and 4-Bone Arthrodesis Versus Proximal Row Carpectomy: A Comparison of Contact Biomechanics. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.05.040

[22] The role of routine radial styloidectomy in proximal row carpectomy: a retrospective review of 120 patients. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221087588

[23] Proximal Row Carpectomy Does Not Alter Contact Pressures of the Lunate Fossa: A Cadaveric Study. HAND. 2022. DOI: 10.1177/15589447221105542

[24] Comparison of the “Contact Biomechanics” of the Intact and Proximal Row Carpectomy Wrist. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2008.12.004

[26] Radiocapitate Congruency as a Predictive Factor for the Results of Proximal Row Carpectomy. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.02.019

[27] Biomechanical Effects of Lunate Excision Alone and Proximal Row Carpectomy on Dart-Throwing Motion, Circumduction, and Carpal Stability: A Cadaveric Study. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101029

[28] Volar Carpus Dislocation Following Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Rare Complication. Journal of Hand Surgery Global Online. 2020. DOI: 10.1016/j.jhsg.2020.04.007

[29] Proximal Row Carpectomy Versus Scaphoid Excision and Intercarpal Arthrodesis: Intraoperative Assessment and Procedure Selection. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.03.032

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.