Name of the Procedure:

Carpectomy; All Bones of Proximal Row

Summary

A carpectomy involving the removal of all the bones in the proximal row of the wrist is a surgical procedure aimed at alleviating pain and improving function in the wrist. It involves excising the scaphoid, lunate, and triquetrum bones, typically to address severe arthritis or other debilitating wrist conditions.

Purpose

The procedure aims to relieve chronic pain, improve wrist function, and enhance the quality of life for patients suffering from conditions like severe osteoarthritis, rheumatoid arthritis, or traumatic injury to the wrist.

Indications

• Chronic wrist pain unresponsive to conservative treatments
• Severe osteoarthritis or rheumatoid arthritis affecting the proximal row of carpal bones
• Advanced post-traumatic arthritis
• Keinbock's disease (avascular necrosis of the lunate)
• Failures of previous wrist surgeries

Preparation

• Fasting from midnight before the surgery day.
• Adjustments or cessation of certain medications (e.g., blood thinners) as advised by the doctor.
• Preoperative diagnostic tests, such as X-rays, MRIs, or CT scans of the wrist.
• Blood tests and general health assessments to ensure the patient's fitness for surgery.

Procedure Description

1. Anesthesia: The patient is given general anesthesia or a regional block to numb the affected arm.
2. Incision: An incision is made on the back of the wrist to expose the carpal bones.
3. Excision: The scaphoid, lunate, and triquetrum bones are carefully removed.
4. Tendons and Ligaments: Adjustments to soft tissues as needed.
5. Closure: The incision is closed with sutures, and a bandage or splint is applied to immobilize the wrist during initial healing.
6. Tools and Equipment: Standard surgical instruments, such as scalpels, retractors, and bone cutters, are used.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Carpectomies are generally performed in a hospital or surgical center, often as an outpatient procedure.

Personnel

• Orthopedic surgeon
• Surgical nurse
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Damage to nearby nerves or blood vessels
• Prolonged pain or stiffness in the wrist
• Incomplete relief of symptoms
• Need for additional surgeries

Benefits

• Relief from chronic pain
• Improved wrist function and range of motion
• Enhanced ability to perform daily activities
• Potential for long-term positive outcomes with significant pain reduction and functionality improvement within a few months post-surgery

Recovery

• Immobilization of the wrist in a cast or splint for a few weeks post-surgery.
• Follow-up visits to monitor healing and remove sutures.
• Gradual rehabilitation involving physical therapy to restore function and strength.
• Full recovery might take several months, with gradual improvement in the range of motion and pain levels.

Alternatives

• Non-surgical treatments like physical therapy, medications, and wrist braces.
• Partial carpectomy, only removing one or two bones.
• Proximal row carpectomy combined with wrist fusion.
• Total wrist fusion, which eliminates pain but restricts motion.
• Pros and cons depend on specific conditions, patient preference, and overall health status.

Patient Experience

• During: The patient will be under anesthesia and not feel pain during the procedure.
• After: Pain and swelling managed with medications; discomfort typically reduces over time.
• Rehabilitation phases include gradual regaining of flexibility and strength, personalized by a physical therapist.
• Patients can expect some discomfort post-surgery, but pain management strategies will be in place to ensure comfort.