Scaphoidectomy and Capsulodesis for SNAC or SLAC Stage II

Abstract

Two common types of wrist arthritis are scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). In stage II SLAC or SNAC, there is arthritis between the scaphoid and the radius, sparing the cartilage between the capitate and the lunate and between the lunate and the radius. When nonsurgical treatment failed, scaphoidectomy plus capsulorrhaphy was used in 8 patients to provide pain relief without requiring an arthrodesis or compromising the radiolunate articulation. After surgery the pain scores improved from 8.5 preoperatively to 2.4 postoperatively. The Disabilities of the Arm, Shoulder, and Hand (DASH) score averaged 21, and the grip strength improved from 18 to 28 kg (81% of the contralateral side).

Keywords

scapholunate advanced collapse (SLAC) arthritis - scaphoid nonunion advanced collapse (SNAC) arthritis - wrist arthritis - scaphoid nonunion - capsulorrhaphy

• References

• 1 Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res 1986; (202) 57-67
• 2 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (1) 39-49
• 3 Krimmer H, Krapohl B, Sauerbier M, Hahn P. Posttraumatic carpal collapse (SLAC- and SNAC-wrist)—stage classification and therapeutic possibilities [in German]. Handchir Mikrochir Plast Chir 1997; 29 (5) 228-233
• 4 Gohritz A, Gohla T, Stutz N , et al. Special aspects of wrist arthritis management for SLAC and SNAC wrists using midcarpal arthrodesis: results of bilateral operations and conversion to total arthrodesis. Bull Hosp Jt Dis 2005; 63 (1-2) 41-48
• 5 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
• 6 Resnick D. SLAC wrist. J Hand Surg Am 1985; 10 (1) 154-155
• 7 Fassler PR, Stern PJ, Kiefhaber TR. Asymptomatic SLAC wrist: does it exist?. J Hand Surg Am 1993; 18 (4) 682-686
• 8 Watson HK, Weinzweig J. Physical examination of the wrist. Hand Clin 1997; 13 (1) 17-34
• 9 Swanson AB, de Groot Swanson G, Maupin BK , et al. Scaphoid implant resection arthroplasty. Long-term results. J Arthroplasty 1986; 1 (1) 47-62
• 10 Egloff DV, Varadi G, Narakas A, Simonetta C, Cantero C. Silastic implants of the scaphoid and lunate. A long-term clinical study with a mean follow-up of 13 years. J Hand Surg [Br] 1993; 18 (6) 687-692
• 11 Swanson AB, de Groot Swanson G, DeHeer DH , et al. Carpal bone titanium implant arthroplasty. 10 years' experience. Clin Orthop Relat Res 1997; (342) 46-58
• 12 Spingardi O, Rossello MI. The total scaphoid titanium arthroplasty: A 15-year experience. Hand (NY) 2011; 6 (2) 179-184
• 13 Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist). Ann Plast Surg 2006; 56 (2) 139-144
• 14 Sauerbier M, Bickert B, Tränkle M, Kluge S, Pelzer M, Germann G. Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist) [in German]. Unfallchirurg 2000; 103 (7) 564-571
• 15 Cohen MS, Kozin SH. Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis. J Hand Surg Am 2001; 26 (1) 94-104