Título / Title

PROXIMAL ROW CARPECTOMY WITH RESURFACING OF BOTH LUNATE FOSSA AND PROXIMAL CAPITATE USING A FEMORAL OSTEOCHONDRAL GRAFT: A CASE-REPORT

Introdução / Introdution

The treatment of the pan-arthritic wrists in the young patients due to traumatic injuries is challenging even for experienced surgeons, especially when both lunate fossa and capitate head are committed with considerable arthritis being the most acceptable option is the total wrist fusion.

Objetivo / Purpose

We present a case-report of an alternative technique of proximal row carpectomy associated with a bifocal osteochondral graft to treat a SNAC wrist type IV in a young patient.

Material e Método / Material and Methods

We performed in a 23 years-old male patient a proximal row carpectomy associated with a bifocal osteochondral graft from the lateral femoral condyle to resurface an important arthritic degeneration of both capitate head and lunate fossa due to a sequel of an open trans-styloid trans-scaphoid perilunate fracture-dissociation. Pre-operatively, he had 20kg of grip strength (50% compared with the contralateral side), 65 degrees of flexion-extension motion (35/30) and pain of intensity of 10/10 in the visual analogic scale.

Resultados / Results

At the 18-month follow-up, the patient is pain-free with the 60 degrees of flexion-extension motion (30/30), 22kg of grip strength (61% when compared with the contra-lateral side), completely integrated graft and no signs of degeneration of the resurfaced area at this follow-up period

Discussão / Discussion

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Conclusão / Conclusion

We conclude that, despite being only one case, the resurface of the capitate head and lunate fossa by osteochondral graft can be an alternative for young patients with advanced arthritis preserving some motion of the wrist.

Palavras Chave / Keywork

SNAC; Osteochondral resurface; Mosaicyplasty; Proximal Row Carpectomy