SURGICAL-TREATMENT OF SCAPHOLUNATE ADVANCED COLLAPSE

This study reports the outcomes of six different reconstructive proced ures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner art hrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Proximal row carpectomy was performed in 12 cases, radioscapholunate arthrodes is in 5 cases, radioscaphoid arthrodesis in 3 cases, and primary total wrist arthrodesis in 4 cases. Following surgical treatment the majori ty of patients in all groups had less wrist pain. The nonunion rate wa s four cases for the capitolunate arthrodesis group compared with two for the four-corner arthrodesis group. Six of 51 motion-sparing cases were converted to total arthrodeses. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with stage III SLAC wrist while maintaining a 54 degrees flexion-extension are. Stag e II SLAC wrist can be successfully treated with this procedure, radio scaphoid arthrodesis, or proximal row carpectomy. Of the three procedu res, proximal row carpectomy best preserves wrist mobility, with a fle xion-extension are of 71 degrees.