gms | German Medical Science

Objectives/Interrogation: Persitent, long-lasting pseudoarthrosis of the scaphoid or scapholunate dissociation results in arthrosis of the radio-scaphoid joint called "scaphoid nonunion advanced collapse, SNAC" or scapholunate advanced collapse, SLAC", which cause pain, reduction of movement of the wrist and weakness of the hand grip. Scaphoid resection followed by midcarpal "four-corner" arthrodesis is a recognized method of management of this condition.

The objective of this study was assessment of long-term outcomes of this technique employed in patients with SNAC and SLAC wrist arthrosis.

Methods: The results of the treatment of 27 patients, 26 men and one woman with SNAC (n=15) and SLAC (n=12) wrist arthritis at a mean of 4 (range 2-8) years after the operation were assessed. The outcome measurements included pain intensity in numeric rating scale, NRS, wrist range of motion, total grip strentgh, and function of the hand with DASH and Mayo questionnaires.

Results and Conclusions: A mean pain score at wrist movements in numeric scale was 3,6 (range 1-5). A mean wrist active range of movement was (affected vs healthy hand) was: flexion 27O vs 58O (46%), extension 27O vs 52O (53%), ulnar deviation 16O vs 26O (62%), radial deviation 9O vs 17O (53%), total grip strength 22 kG vs 29 kG (76%), DASH scores a mean of 22 (range 4-36) and Mayo scores a mean of 72 (range 65-80). None of the patients required revision surgery. Of the 16 patients employed prior to operation 10 returned to work after a mean of 4 months sick-leave.

The resection of degenerated scaphoid bone followed by midcarpal arthrodesis is an effective treatment of SNAC and SLAC wrist arthrosis, resulting in pain cessation and improvement of hand dexterity, at the cost of mild reduction of wrist movements.