Abstract
Long-standing scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation
result in malalignment of the carpal bones, progressive carpal collapse, instability,
and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid
nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists
are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). The purpose
of this study was to evaluate the clinical outcome of a different treatment modality:
radial styloidectomy and scaphocapitolunate (SCL) arthrodesis. This treatment option
is chosen in an effort to maintain the joint contact surface and load transmission
across the radiocarpal joint. We conducted a retrospective review of 20 patients (average
age 62 years, range: 27 to 75 years) treated from 1994 to 2010. Seven patients were
treated for SNAC, 12 patients for SLAC wrists, and 1 for degenerative joint disease
following a transscapho-transcapitate perilunar dislocation. Sixteen patients had
Herbert screw fixation, and four had Spider plate fixation. All patients had autologous
bone graft used for the arthrodesis. The mean follow-up was 4.6 years (range: 2 to
9.6 years). Patients were evaluated clinically and radiographically. Nineteen of 20
arthrodeses healed on an average of 9.6 weeks. One patient was reoperated 8 months
after the initial operation with salvage of the SCL arthrodesis with a spider plate
with an adequate result. The mean active flexion–extension arc was 70 degrees and
the radioulnar deviation arc was 23 degrees. Pain decreased in all patients, 13 of
whom were pain free postoperatively. The average postoperative disabilities of arm,
shoulder, and hand score was 24. Radiographically, neither radiolunate nor radioscaphoid
arthritis was noted on follow-up. SCL arthrodesis with radial styloidectomy resulted
in an adequate residual range of motion and pain relief. This method preserves the
normal ulnar sided joints of the carpus and maintains a more physiologic joint surface
for radiocarpal load sharing.
Keywords
scaphocapitolunate - wrist arthrodesis - SNAC - SLAC
