Proximal Row Carpectomy (for advanced arthritic wrist pain)
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Learn the Proximal Row Carpectomy (for advanced arthritic wrist pain) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Proximal Row Carpectomy (for advanced arthritic wrist pain) surgical procedure.
This is a detailed step by step instruction through a proximal Row Carpectomy (PRC), a procedure in which the proximal row of carpal bones (Scpahoid, Lunate and Triquetrum) are removed.
The PRC is a salvage operation usually undertaken for wrist pain when the scaphoid fossa is damaged and arthritic. The most common cause for this is a Scapho-Lunate advanced collapse (SLAC) stage 2. The procedure can also be used for Keinbock’s disease, proximal carpal row instability resistant to initial surgery or if the wrist needs to be shortened due to trauma or Volkmann’s ischemic contracture.
The critical point in planning this surgery is that the lunate fosse of the radius and the proximal capitate must be free from damage.
During the surgery the wrist capsule is tightened and allowed to scar up to create a stable but mobile Neo-wrist joint.
Following a period of 6-8 weeks in plaster cast and then rehabilitation, it is expected the patient will achieve around 50% of their normal range of movement.
Once the wrist is fully healed and strengthened around 6 months post surgery then heavy work is possible although the range of motion and grip strength will be limited to around 50% and 65% respectively.
One of the common alternative treatments to PRC is a four corner fusion. The advantage of a PRC over the technique is a slightly increased post operative range of movement, a lack of a need for metalwork, the PRC is less technically demanding and no bone healing required, an advantage in the unrepentant smoker.
Readers will also find of interest the OrthOracle instructional technique Four Corner carpal Fusion using Medartis plate and scaphoid excision
Author:Mark Brewster FRCS (Tr & Orth)
Institution: The Royal Orthopaedic hospital, Birmingham, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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