Long-Term Results of Midcarpal Arthrodesis in the Treatment of Scaphoid Nonunion Advanced Collapse (SNAC-Wrist) and Scapholunate Advanced Collapse (SLAC-Wrist)

Dacho, Andreas; Grundel, J.; Holle, Gisbert; Germann, Günter; Sauerbier, Michael

doi:10.1097/01.sap.0000194245.94684.54

Cited by 57 publications

(43 citation statements)

References 35 publications

(32 reference statements)

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“…11 Singlecolumn fusion also requires less amount of graft, reduces operating time, and is generally perceived as a less technically demanding surgery. 4,11 The authors acknowledge some weaknesses of the present study such as being a cadaveric study in which only specific positions and the limited number of specimens that were analyzed. Also, advanced-stage wrist collapse was not present in our study sample.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure was introduced over two decades ago and is currently the gold-standard treatment for reconstruction 17 because of its high reported success rate. [4][5][6] The four-corner arthrodesis was not biomechanically tested for comparison in the present study. There is currently no consensus regarding the "center of rotation" of the wrist; however, most authors agree that if one exists, it will be found in the head of the capitate, for both palmar-dorsiflexion and radial-ulnar deviation.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is currently no consensus regarding the type of arthrodesis that should be performed. The most commonly performed technique is the bi-column 3 or four-corner arthrodesis 4 with scaphoidectomy, which entails fusion of the lunate, capitate, hamate, and triquetrum and excision of the scaphoid. Fourcorner arthrodesis procedures have been reported to yield high union rates with low complication rates and only partial loss of wrist mobility.…”

mentioning

confidence: 99%

“…Fourcorner arthrodesis procedures have been reported to yield high union rates with low complication rates and only partial loss of wrist mobility. [4][5][6][7] However, this surgery entails longer operative times, a bigger exposure, and consequently greater soft tissue damage. Partial arthrodesis of the lunate-capitate is another common procedure, initially proposed to preserve wrist mobility with a stable midcarpal fusion.…”

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confidence: 99%

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Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study

et al. 2016

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Altered wrist biomechanics consequent to a scapholunate dissociation or a scaphoid nonunion accelerates the degeneration of the surrounding articular surfaces and often induces arthritic progression referred to as a scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC). 1,2Watson and Ballet described four stages of the arthritic progression of the affected articulations. 2 Stage III progression is determined by radiological evidence of degenerative changes to both the radioscaphoid and the lunate-capitate joint surfaces, and is generally associated with progressive pain and reduced wrist Keywords ► scaphoid nonunion advanced collapse ► arthritis ► advanced collapse ► biomechanics ► wrist AbstractBackground Scapholunate advanced collapse and scaphoid nonunion advanced collapse result in high morbidity and pose significant challenges for active patients. Multiple treatment options have been proposed to yield satisfactory results; however, restoration of physiological wrist motion remains an issue. Questions/Purposes The objective of this study was to compare wrist mobility after four different treatment methods for grade III wrist collapse: (1) no treatment, (2) scaphoidectomy and lunate-capitate arthrodesis, (3) scaphoidectomy, lunate-capitate arthrodesis, and triquetrum-hamate arthrodesis, and (4) scaphoidectomy, lunatecapitate arthrodesis, and triquetrum excision. Methods Four paired (n ¼ 8) fresh-frozen human cadaveric upper limbs were used in this controlled laboratory study. Computed tomography scans were collected at all testing states and measurements were made to evaluate midcarpal joint mobility and alignment. Results A significant decrease in wrist extension was observed for all treatments. Middle column and two-column arthrodesis demonstrated no significant differences for carpal alignment and mobility. No significant differences were observed for triquetrumhamate mobility or wrist extension between the partial and two-column arthrodesis. Triquetrum excision significantly improved ulnar deviation. Conclusion The most important finding of this study was that the one-column arthrodesis has comparable carpal alignment and range of motion to that of bi-column arthrodesis. Clinical Relevance The results of this study suggest that a stage III advanced wrist collapse can be treated by isolated lunate-capitate arthrodesis with scaphoidectomy. Fusion between the remaining carpal bones may not be necessary because the carpal alignment and range of motion of the remaining joints were not significantly different in the present study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study

et al. 2016

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“…Conversely, scaphocapitate arthrodesis is rarely used to treat arthritis, but rather to provide a functional result similar to treatment options for STT arthritis, allowing for its use in the reduction of the SL interval and for offloading the lunate in the treatment of Kienbock disease (19,20). Scaphoid excision with four-corner fusion can be used in treating scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) (21,22).…”

Section: Midcarpal Arthrodesismentioning

confidence: 99%