Proximal Row Carpectomy Darrach Allograft Arthroplasty

This case demonstrates severe radio-carpal joint and distal radio-ulnar joint arthrosis. If the lunate fossa of the radius is preserved a proximal row carpectomy can be performed allowing the capitate to articulate with the distal radius in the lunate fossa. If the lunate fossa and/or proximal capitate is involved and shows degenerative arthritic changes an interposition arthroplasty is required. The distal radio-ulnar joint arthitis is treated by resection of the distal end of the ulna (Darrach Procedure).

Severe radio-carpal and distal radio-ulnar joint arthritis seen on PA radiographs.







The distal ulna is seen here with Homman’s retractors exposing the neck of the distal ulna in the region where the head of the ulna will be resected for the Darrach procedure.






The proximal row carpectomy has been performed removing the scaphoid, lunate and triquetrum leaving a space for the graft to be inserted.






Fascia lata allograft is folded on itself and sutured to maintain the desired shape that will occupy the void created by the proximal row carpectomy.






The graft has been inserted into the area of the carpectomy completely filling the space.







Post-operative radiograph showing the distal ulnar resection and the absence of the proximal carpal row and the interval maintained by the graft. This procedure eliminated the arthritic pain since the arthritic bones are no longer able to grind upon eachother.