Scaphoidectomy and Double Column Midcarpal Arthrodesis for SLAC and SNAC Stage III°

Introduction One surgical option for the treatment for SLAC and SNAC stage III° is the midcarpal arthrodesis with scaphoidectomy. Various methods of synthesis for arthrodesis are used from simple K-wires to headless screws and intercarpal plates.

We present our experience of this technique according to the procedure of the two columns arthrodesis (luno-capitate and triquetrum-hamate) by using the Herbert screws introduced in a proximo-distal direction.

Materials and Methods From 2001 to 2012 we treated 93 cases of SLAC and SNAC wrist stage III°. Sixty-one of them had midcarpal arthrodesis according to the two columns technique. All cases were submitted to preoperative and postoperative X-rays, clinical evaluation according with Mayo score, and DASH and PRWE questionnaries. Arthroscopy was done in all cases to obtain precise information about the condition of the joint before open surgery.

Results At a mean follow-up of nine months, 34 cases (30 males and 4 females with a mean age of 50 years) were controlled. No complications or failures occurred. SLAC and SNAC had an equal distribution in this series (16 and 15 cases respectively). Pain showed an important decrease from 8 to 3 (VAS scale), wrist ROM globally reduced (flexion-extension from 83° to 54°, while radio-ulnar deviation from 24° to 20°); grip strength slightly improved. Mayo score showed an increase from 34 to 55. All cases showed a radiographic complete consolidation and almost all the patients returned to the previous work in three months.

Conclusion The technique of double column midcarpal arthrodesis for SLAC and SNAC stage III° provides good results in terms of early clinical recovery, fusion of the arthrodesis, patient satisfaction, and an earlier return to work.