Operative treatment of advanced carnal collapse (SNAC/SLAC wrist)

Longstanding and untreated scaphoid fractures and scapholunate dissociation s lead to painful destruction of the wrist with carpal collapse. The severi ty of degenerative arthrosis is classified in three stages and can be treat ed adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) a fter failed fusion of the scaphoid and SLAC wrist (scapholunate advanced co llapse) after scapholunate dissociation should be differentiated. The recon struction of the scaphoid or scapholunate ligament in stage II and III is n o reasonable option. Motion preserving procedures such as proximal row carp ectomy or midcarpal arthrodesis are preferable in this situation. Thirty-on e male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined,the mean followup was 15 months. Grip strength was measured with the Dexter(TM)-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activitie s and general quality of life were estimated with the DASH-questionnaire. P ain was reduced to 50% compared to the preoperative situation. Grip strengt h improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39,0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in t otal wrist arthrodesis. 80% of the patients returned to their original occu pation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignement of the carpus is performed. The DASH-score reflects the subjective impressions of the pa tients in daily life and justifies the choice of a salvage procedure preser ving wrist mobility. Total wrist fusion represents the last line of defense .