A three-dimensional (3D) computational model of the wrist examined the biomechanical effects of the proximal row carpectomy (PRC), a surgical treatment of certain wrist degenerative conditions but with functional consequences. Model simulations, replicating the 3D bony anatomy, soft tissue restraints, muscle loading, and applied perturbations, demonstrated quantitatively accurate responses for the decreased motions subsequent to the surgical procedure. It also yielded some knowledge of alterations in radiocarpal contact force which likely increase contact pressure as well as additional insight into the importance of the triangular fibrocartilage complex and retinacular/capsular structures for stabilizing the deficient wrist. As better understanding of the wrist joint is achieved, this model could serve as a useful clinical tool.

References

1.
Cohen
,
M. S.
, and
Kozin
,
S. H.
,
2001
, “
Degenerative Arthritis of the Wrist: Proximal Row Carpectomy Versus Scaphoid Excision and Four Corner Arthrodesis
,”
J. Hand Surg. Am.
,
26
(
1
), pp.
94
104
.10.1053/jhsu.2001.20160
2.
Culp
,
R. W.
, and
Williams
,
C. S.
,
2001
, “
Proximal Row Carpectomy for the Treatment of Scaphoid Nonunion
,”
Hand Clin.
,
17
(
4
), pp.
663
669
.
3.
Nakamura
,
R.
,
Horii
,
E.
,
Watanabe
,
K.
,
Nakao
,
E.
,
Kato
,
H.
, and
Tsunoda
,
K.
,
1998
, “
Proximal Row Carpectomy Versus Limited Wrist Arthrodesis for Advanced Kienböck's Disease
,”
J. Hand Surg. Br. Eur. Vol.
,
23
(
6
), pp.
741
745
.10.1016/S0266-7681(98)80087-9
4.
Steenwerckx
,
A.
,
De Smet
,
L.
,
Zachee
,
B.
, and
Fabry
,
G.
,
1997
, “
Proximal Row Carpectomy: An Alternative to Wrist Fusion?
,”
Acta Orthop. Belg.
,
63
(
1
), pp.
1
7
.
5.
DiDonna
,
M. L.
,
Kiefhaber
,
T. R.
, and
Stern
,
P. J.
,
2004
, “
Proximal Row Carpectomy: Study With a Minimum of Ten Years of Follow-Up
,”
J. Bone Joint Surg.
,
86A
(
11
), pp.
2359
2365
.
6.
Imbriglia
,
J. E.
,
Broudy
,
A. S.
,
Hagberg
,
W. C.
, and
McKernan
,
D.
,
1990
, “
Proximal Row Carpectomy: Clinical Evaluation
,”
J. Hand Surg. Am.
,
15
(
3
), pp.
426
430
.10.1016/0363-5023(90)90054-U
7.
Blankenhorn
,
B. D.
,
Pfaeffle
,
H. J.
,
Tang
,
P.
,
Robertson
,
D.
,
Imbriglia
,
J.
, and
Goitz
,
R. J.
,
2007
, “
Carpal Kinematics After Proximal Row Carpectomy
,”
J. Hand Surg. Am.
,
32
(
1
), pp.
37
46
.10.1016/j.jhsa.2006.10.014
8.
Tang
,
P.
,
Gauvin
,
J.
,
Muriuki
,
M.
,
Pfaeffle
,
H. J.
,
Imbriglia
,
J. E.
, and
Goitz
,
R. J.
,
2009
, “
Comparison of the ‘Contact Biomechanics' of the Intact and Proximal Row Carpectomy Wrist
,”
J. Hand Surg. Am.
,
34
(
4
), pp.
660
670
.10.1016/j.jhsa.2008.12.004
9.
Horii
,
E.
,
Garcia-Elias
,
M.
,
Bishop
,
A. T.
,
Cooney
,
W. P.
,
Linscheid
,
R. L.
, and
Chao
,
E. Y.
,
1990
, “
Effect on Force Transmission Across the Carpus in Procedures Used to Treat Kienböck's Disease
,”
J. Hand Surg. Am.
,
15
(
3
), pp.
393
400
.10.1016/0363-5023(90)90049-W
10.
Schuind
,
F.
,
Cooney
,
W. P.
,
Linscheid
,
R. L.
,
An
,
K. N.
, and
Chao
,
E. Y.
,
1995
, “
Force and Pressure Transmission Through the Normal Wrist. A Theoretical Two-Dimensional Study in the Posteroanterior Plane
,”
J. Biomech.
,
28
(
5
), pp.
587
601
.10.1016/0021-9290(94)00093-J
11.
Manal
,
K.
,
Lu
,
X.
,
Nieuwenhuis
,
M. K.
,
Helders
,
P. J. M.
, and
Buchanan
,
T. S.
,
2002
, “
Force Transmission Through the Juvenile Idiopathic Arthritic Wrist: A Novel Approach Using a Sliding Rigid Body Spring Model
,”
J. Biomech.
,
35
(
1
), pp.
125
133
.10.1016/S0021-9290(01)00108-7
12.
Iwasaki
,
N.
,
Genda
,
E.
,
Barrance
,
P. J.
,
Minami
,
A.
,
Kaneda
,
K.
, and
Chao
,
E. Y.
,
1998
, “
Biomechanical Analysis of Limited Intercarpal Fusion for the Treatment of Kienböck's Disease: A Three-Dimensional Theoretical Study
,”
J. Orthop. Res.
,
16
(
2
), pp.
256
263
.10.1002/jor.1100160213
13.
Genda
,
E.
, and
Horii
,
E.
,
2000
, “
Theoretical Stress Analysis in Wrist Joint—Neutral Position and Functional Position
,”
J. Hand Surg. Br. Eur. Vol.
,
25
(
3
), pp.
292
295
.10.1054/jhsb.2000.0388
14.
Majima
,
M.
,
Horii
,
E.
,
Matsuki
,
H.
,
Hirata
,
H.
, and
Genda
,
E.
,
2008
, “
Load Transmission Through the Wrist in the Extended Position
,”
J. Hand Surg. Am.
,
33
(
2
), pp.
182
188
.10.1016/j.jhsa.2007.10.018
15.
Matsuki
,
H.
,
Horii
,
E.
,
Majima
,
M.
,
Genda
,
E.
,
Koh
,
S.
, and
Hirata
,
H.
,
2009
, “
Scaphoid Nonunion and Distal Fragment Resection: Analysis With Three-Dimensional Rigid Body Spring Model
,”
J. Orthop. Sci.
,
14
(
2
), pp.
144
149
.10.1007/s00776-008-1310-y
16.
Fischli
,
S.
,
Sellens
,
R.
,
Beek
,
M.
, and
Pichora
,
D.
,
2009
, “
Simulation of Extension, Radial and Ulnar Deviation of the Wrist With a Rigid Body Spring Model
,”
J. Biomech.
,
42
(
9
), pp.
1363
1366
.10.1016/j.jbiomech.2009.03.008
17.
Majors
,
B. J.
, and
Wayne
,
J. S.
,
2011
, “
Development and Validation of a Computational Model for Investigation of Wrist Biomechanics
,”
Ann. Biomed. Eng.
,
39
(
11
), pp.
2807
2815
.10.1007/s10439-011-0361-y
18.
An
,
K. N.
,
Berger
,
R. A.
, and
Cooney
,
W. P.
,
1991
,
Biomechanics of the Wrist Joint
,
Springer-Verlag
,
New York
.
19.
Palmer
,
A. K.
, and
Werner
,
F. W.
,
1981
, “
The Triangular Fibrocartilage Complex of the Wrist—Anatomy and Function
,”
J. Hand Surg. Am.
,
6
(
2
), pp.
153
162
.10.1016/S0363-5023(81)80170-0
20.
Palmer
,
A. K.
,
Skahen
,
J. R.
,
Werner
,
F. W.
, and
Glisson
,
R. R.
,
1985
, “
The Extensor Retinaculum of the Wrist: An Anatomical and Biomechanical Study
,”
J. Hand Surg. Br. Eur. Vol.
,
10
(
1
), pp.
11
16
.10.1016/S0266-7681(85)80006-1
21.
Liacouras
,
P. C.
, and
Wayne
,
J. S.
,
2007
, “
Computational Modeling to Predict Mechanical Function of Joints—Application to the Lower Leg With Simulation of Two Cadaver Studies
,”
ASME J. Biomech. Eng.
,
129
(
6
), pp.
811
817
.10.1115/1.2800763
22.
Fisk
,
J. P.
, and
Wayne
,
J. S.
,
2009
, “
Development and Validation of a Computational Musculoskeletal Model of the Elbow and Forearm
,”
Ann. Biomed. Eng.
,
37
(
4
), pp.
803
812
.10.1007/s10439-009-9637-x
23.
Iaquinto
,
J. M.
, and
Wayne
,
J. S.
,
2010
, “
Computational Model of the Lower Leg and Foot/Ankle Complex: Application to Arch Stability
,”
ASME J. Biomech. Eng.
,
132
(
2
), p.
021009
.10.1115/1.4000939
24.
Spratley
,
E. M.
, and
Wayne
,
J. S.
,
2011
, “
Computational Model of the Human Elbow and Forearm—Application to Complex Varus Instability
,”
Ann. Biomed. Eng.
,
39
(
3
), pp.
1084
1091
.10.1007/s10439-010-0224-y
25.
Spratley
,
E. M.
,
Matheis
,
E. A.
,
Hayes
,
C. W.
,
Adelaar
,
R. S.
, and
Wayne
,
J. S.
,
2014
, “
A Population of Patient-Specific Adult Acquired Flatfoot Deformity Models Before and After Surgery
,”
Ann. Biomed. Eng.
,
42
(
9
), pp.
1913
1922
.10.1007/s10439-014-1048-y
26.
Netter
,
F. H.
,
2010
,
Atlas of Human Anatomy, Professional Edition
, 5th ed.,
W.B. Saunders Co., St. Louis MO
.
27.
Agur
,
A. M.
, and
Dalley
,
A. F.
,
2008
,
Grant's Atlas of Anatomy
, 12th ed.,
Lippincott Williams & Wilkins
,
Philadelphia, PA
.
28.
Rohen
,
J. W.
,
Lutjen-Drecoll
,
E.
, and
Yokochi
,
C.
,
2006
, Color Atlas of Anatomy: A Photographic Study of the Human Body
, Sixth ed.,
Lippincott Williams & Wilkins
,
Philadelphia, PA
.
29.
Mayfield
,
J. K.
, and
Williams
,
W. J.
,
1979
, “
Biomechanical Properties of Human Carpal Ligaments
,”
Orthop. Trans.
,
3
, pp.
143
144
.
30.
Nowalk
,
M. D.
, and
Logan
,
S. E.
,
1991
, “
Distinguishing Biomechanical Properties of Intrinsic and Extrinsic Human Wrist Ligaments
,”
ASME J. Biomech. Eng.
,
113
(
1
), pp.
85
93
.10.1115/1.2894089
31.
Schuind
,
R.
,
An
,
K. N.
,
Berglund
,
L.
,
Rey
,
R.
,
Cooney
,
W. P.
,
Linscheid
,
R. L.
, and
Chao
,
E. Y.
,
1991
, “
The Distal Radioulnar Ligaments: A Biomechanical Study
,”
J. Hand Surg. Am.
,
16
(
6
), pp.
1106
1114
.10.1016/S0363-5023(10)80075-9
32.
Garcia-Elias
,
M.
,
An
,
K. N.
,
Cooney
,
W. P.
,
Linscheid
,
R. L.
, and
Chao
,
E. Y.
,
1989
, “
Stability of the Transverse Carpal Arch: An Experimental Study
,”
J. Hand Surg. Am.
,
14
(
2 Part 1
), pp.
277
282
.10.1016/0363-5023(89)90021-X
33.
Pervaiz
,
K.
,
Bowers
,
W. H.
,
Isaacs
,
J. E.
,
Owen
,
J. R.
, and
Wayne
,
J. S.
,
2009
, “
Range of Motion Effects of Distal Pole Scaphoid Excision and Triquetral Excision After Radioscapholunate Fusion: A Cadaver Study
,”
J. Hand Surg. Am.
,
34
(
5
), pp.
832
837
.10.1016/j.jhsa.2009.02.007
34.
Fuss
,
F. K.
, and
Wagner
,
T. F.
,
1996
, “
Biomechanical Alterations in the Carpal Arch and Hand Muscles After Carpal Tunnel Release: A Further Approach Toward Understanding the Function of the Flexor Retinaculum and the Cause of Postoperative Grip Weakness
,”
Clin. Anat.
,
9
(
2
), pp.
100
108
.10.1002/(SICI)1098-2353(1996)9:2<100::AID-CA2>3.0.CO;2-L
35.
Berkhout
,
M. J.
,
Shaw
,
M. N.
,
Berglund
,
L. J.
,
An
,
K. N.
,
Berger
,
R. A.
, and
Ritt
,
M. J. P. F.
,
2010
, “
The Effect of Radioscapholunate Fusion on Wrist Movement and the Subsequent Effects of Distal Scaphoidectomy and Triquetrectomy
,”
J. Hand Surg. Eur.
,
35
(
9
), pp.
740
745
.10.1177/1753193410370926
36.
McCombe
,
D.
,
Ireland
,
D. C.
, and
McNab
,
I.
,
2001
, “
Distal Scaphoid Excision After Radioscaphoid Arthrodesis
,”
J. Hand Surg. Am.
,
26
(
5
), pp.
877
882
.10.1053/jhsu.2001.27762
37.
Wyrick
,
J. D.
,
Stern
,
P. J.
, and
Kiefhaber
,
T. R.
,
1995
, “
Motion-Preserving Procedures in the Treatment of Scapholunate Advanced Collapse Wrist: Proximal Row Carpectomy Versus Four-Corner Arthrodesis
,”
J. Hand Surg. Am.
,
20
(
6
), pp.
965
970
.10.1016/S0363-5023(05)80144-3
38.
Jebson
,
P. J.
,
Hayes
,
E. P.
, and
Engber
,
W. D.
,
2003
, “
Proximal Row Carpectomy: A Minimum 10-Year Follow-Up Study
,”
J. Hand Surg. Am.
,
28
(
4
), pp.
561
569
.10.1016/S0363-5023(03)00248-X
39.
Wall
,
L. B.
,
DiDonna
,
M. L.
,
Kiefhaber
,
T. R.
, and
Stern
,
P. J.
,
2013
, “
Proximal Row Carpectomy: Minimum 20-Year Follow-Up
,”
J. Hand Surg. Am.
,
38
(
8
), pp.
1498
1504
.10.1016/j.jhsa.2013.04.028
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