Outcomes after Scaphoid Excision and Midcarpal Arthrodesis for SNAC and SLAC Wrist Arthritis

Abstract

Background. Persistent, long-lasting pseudoarthrosis of the scaphoid or scapholunate dissociation results in arthrosis of the radio-scaphoid joint termed scaphoid non-union advanced collapse (SNAC) or scapholunate advanced collapse (SLAC), which causes pain, reduction in wrist movements and weakness of the hand grip. Scaphoid resection followed by „four-corner” midcarpal arthrodesis is a recognized treatment for this condition. Material and methods. The study evaluated the results of treatment of 27 patients with arthrosis of the wrist type SNAC (n = 15) and SLAC (n = 12) after an average of 4 years after surgery (range from 2 to 8 years) Results. The mean numerical pain score for wrist movements was 3.6 (range: 1-5). The mean active range of wrist movement (affected vs healthy hand) was: flexion 27° vs 58° (46%), extension 27° vs 52° (53%), ulnar deviation 16° vs 26° (62%), radial deviation 9° vs 17° (53%), total grip strength 22 kG vs 29 kG (76%), The mean DASH score was 22 (range: 4-36) and the mean Mayo score was 72 (range: 65-80). None of the patients required revision surgery. Of the 16 patients employed prior to the surgery, 10 returned to work after a mean of 4 months of sick leave. Conclusions. 1. The results of the treatment presented in this stu­dy, after a relatively long follow-up period, show a beneficial effect of the surgery on pain intensity and improvement of hand dexterity, at the cost of a mild reduction in wrist movements. 2. It seems that this technique offers good, predicta­ble outcomes and may be recommended for Wa­t­son 2° and 3° SNAC or SLAC wrist arthrosis.

Midcarpal Arthrodesis with or without Excision of Triquetrum: A Systematic Review

“…The triquetrum excision group ( n = 75, 4 studies 8 11 14 15 ) showed improvement in the differences between pre-and postoperative F–E arc motion compared with the 4CF group ( n = 261, 10 studies 21 23 24 28 31 33 34 35 38 40 ) of 5.8 degrees versus −11 degrees ( Table 3 ). Similarly, the triquetrum excision group ( n = 62, three studies 8 14 15 ) showed improvement in the R–U arc motion compared with the 4CF group ( n = 251, nine studies 21 23 28 31 33 34 35 38 40 ) with a difference of 5 degrees versus −3 degrees ( Table 3 ).…”

“…1 . There were 21 4CF articles 9 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 and 11 2/3CF articles 5 8 9 11 14 15 16 17 18 19 41 included for analysis ( Fig. 1 ).…”

“…4CF group (n ¼ 263, nine studies 21,23,28,30,31,33,35,38,40 ) showed a larger improvement in grip strength of 10.07 kg as opposed to and improvement of only 1.37 kg in the triquetrum excision group (n ¼ 75, four studies 8,11,14,15 ) (►Table 4). Improvement of pain were quite similar with triquetrum excision group showing an improvement of 5.57 points (n ¼ 45, three studies 8,11,14 ) and 4CF group (n ¼ 312, 10 studies 9,21,23,25,[28][29][30][31]36,38 ) showing an improvement of 4.47 after surgery (►Table 4).…”

Hand and wrist – what the hand surgeon wants to know from the radiologist

“…In these conditions, surgical procedures are planned based on the status of the joint preservation from the disease. For instance, if the lunate fossa and capitate cartilage are spared, proximal row carpectomy is an acceptable choice in radiocarpal arthritis or lunate avascular necrosis cases [9][10][11].…”