SLAC & SNAC wrists Management & Results. Satyam Patel January 19th, 2007. Overview. Definitions Natural history Treatment Options Results. SLAC = Scapho-Lunate Advanced Collapse SNAC = Scaphoid Nonunion Advanced Collapse PRC = proximal row carpectomy
January 19th, 2007
SNAC = Scaphoid Nonunion Advanced Collapse
PRC = proximal row carpectomy
4CF = 4 corner (Capito-Hamate-Lunate-Triquetrum) FusionDefinition
Wrist motion occurs through preserved radiolunate and ulnocarpal joints
Including hamate and triquetrum increases fusion rate without sacrificing further motion
CI’s = radiolunate degeneration, ulnar carpal translation
Capitate articulates with lunate fossa
Difference in arc of rotation between C & L allows for radial and ulnar deviation
Preserving radio-scapho-capitate ligament is important for stability (N.B. if doing styloidectomy)Biomechanical basis for treatment
Degenerative Arthritis of the Wrist : Proximal Row Carpectomy versus Scaphoid excision and four-corner arthrodesis.
M. Cohen S. Kozin J. Hand Surg. 2001 26A:94-104
2 cohorts of 19 patients each largely stage 2 arthritis, most SLAC, 3 SNAC in one arm 6 in the other.
- Early follow-up results (DASH, SF-36)
No significant differences in pain, grip strength, ROM
4CF group scored higher on mental-health component of SF-36 and retained a slightly greater radial-ulnar deviation arc.
Hastings and Silver
Krakauer et al, 1994
Wyrick et al, 1995
Tomaino et al, 1994