Proximal Row Carpectomy Versus 4-Corner Fusion: Regional Differences, Incidence, and Conversion to Fusion

Ownership Interest: Medtronic, Zimmer Biomet, AxoGen, Stryker (Alluri) Proximal row carpectomy (PRC) and 4-corner fusion (4CF) are the 2 common salvage procedures utilized in the treatment of scaphoid nonunion (SNAC) and scapholunate advance collapse (SLAC). We hypothesized that 4CF and PRC would both have increased incidence from 2005 to 2014 across Medicare patients, and that 4CF would have higher rates of conversion to fusion and higher cost burden compared with PRC. A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from 2005 through 2014 among Medicare enrollees. Regional distribution, demographic characteristics, annual incidence, comorbidities, and conversion to wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age and sex matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average cost. Demographically, the patients undergoing 4CF and PRC did not have statistically significant differences in age, sex, or comorbidities. The incidence of the procedures among all Medicare subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,0000) from 2005 to 2014. When comparing matched cohorts, patients who underwent 4CF had a higher rate of conversion to fusion compared with those who underwent PRC (2.67% vs 1.79%, P < 0.0067). Readmission rates were not significantly different at 30 or 90 days (P = 0.07 and 0.64, respectively). Average cost was significantly greater for 4CF compared with PRC (P < .0001). •PRC and 4CF have been utilized at increasing rates in the past decade for the treatment of scaphoid nonunion and scapholunate advanced collapse.•Regional differences may exist with a predilection toward PRC in the Northeast and 4CF in the West.•Wrist fusion rates and average cost are higher in the 4CF group without a significant difference in readmission rates.