Recurrence rate and patient-reported outcomes after wedge excision of carpal boss

Recurrence rate and patient-reported outcomes after wedge excision of carpal boss

The treatment of carpal boss is primarily conservative. Surgical treatment by performing a wedge excision of the bony protrusion, is possible. However, a common belief exists that carpal boss should not be operated because of the high recurrence rate. Additionally, little is known about the clinical...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery Vol. 92; pp. 179 - 185
Main Authors: Raymakers, Anne M., van der Oest, Mark J.W., Duraku, Liron S., Hundepool, Caroline A., Zuidam, J. Michiel, Vermeulen, Guus M.
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-05-2024
Subjects:
Adult
Carpal Bones - surgery
Carpal boss
Female
Hand surgery
Humans
Male
Middle Aged
Pain Measurement
Patient Reported Outcome Measures
Patient Satisfaction
Patient-reported outcomes
Recurrence
Reoperation - statistics & numerical data
Splints
Treatment Outcome
Wedge excision
Wrist surgery
Recurrence
Carpal boss
Wedge excision
Patient-reported outcomes
Wrist surgery
Hand surgery
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Summary:The treatment of carpal boss is primarily conservative. Surgical treatment by performing a wedge excision of the bony protrusion, is possible. However, a common belief exists that carpal boss should not be operated because of the high recurrence rate. Additionally, little is known about the clinical outcomes of wedge excision and the preferred post-operative treatment. Patients with carpal boss and persisting pain who underwent wedge excision after conservative treatment were included. They received questionnaires before and three months after surgery. The primary outcomes were pain and hand function measured using patient-reported wrist evaluations (PRWE). Secondarily, recurrence, patient satisfaction and time until return to work were evaluated. These clinical outcomes were also compared between patients who received a plaster splint or a pressure dressing post-operatively. 76 patients were included. Three months after surgery, a significant improvement in PRWE was seen, for both pain and function. A re-operation rate for recurrent carpal boss of 13% was observed. After three months, 58% of patients were satisfied and 73% had returned to work. While no differences in clinical outcomes were found, patients were more satisfied after receiving a pressure dressing than a plaster splint post-operatively. The current study demonstrates encouraging early outcomes after wedge excision, and a low recurrence re-operation rate. Furthermore, a pressure dressing seems preferable post-operatively compared to a plaster splint.
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ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2024.02.067