Proximal Row Carpectomy with Resurfacing Capitate Pyrocarbon Implant with Bone Graft for Scaphoid Nonunion Advanced Collapse III Wrist with Total Intramedullary Bone Resorption of the Capitate: A Case Report

INTRODUCTION: One treatment of advanced carpal collapse with osteoarthritis of the midcarpal joint can be proximal row carpectomy (PRC) with pyrocarbon prosthesis implant, replacing the head of the capitate. We report a case of scaphoid nonunion advanced collapse (SNAC) III wrist with intramedullary bone resorption of the capitate. CASE REPORT: A 55-year-old man had major functional impotence of the wrist and right hand with an extremely evolved SNAC III wrist with completely intramedullary bone resorption of the capitate. On the basis of this diagnosis and due to refractory severe pain that did not respond to conservative treatment, we discussed 3 therapeutic options: PRC with resurfacing capitate pyrocarbon implant (RCPI) in case of a possible large bone graft intraoperatively, a pyrocarbon intermediate prosthesis like adaptative proximal scaphoid implant which is interposed between the radius and the second carpal row, or a complete arthrodesis of the wrist. He was successfully managed by capitate pyrocarbon prosthesis associated with capitate bone graft. The patient presented no pain and was satisfied with the operation. The X-ray showed a stable prosthesis. CONCLUSION: Treatment of advanced carpal collapse with osteoarthritis of the midcarpal joint can be PRC with RCPI. However, when bone resorption of the capitate exists, surgical treatment usually is a wrist arthrodesis which is a good pain relief but blocks all movements. PRC with RCPI with bone graft can be a good alternative solution with pain relief and preservation of wrist mobility.