Diagnosis and Management of Scapholunate Advanced Collapse Wrist


Scapholunate advanced collapse (SLAC) is a common pattern of arthritis of the wrist characterized by radiographic findings of scapholunate dissociation accompanied by varying degrees of arthritic change involving the radius, lunate, scaphoid, and capitate bones. The condition is thought to be most commonly caused by a traumatic disruption of the scapholunate ligament, although nontraumatic conditions may also compromise the integrity of the scapholunate articulation. Nonsurgical treatment may suffice for many patients with SLAC of the wrist; however, no studies have been done of the long-term success of nonsurgical treatment of SLAC of the wrist, nor have any long-term studies been done of its natural history. Surgical procedures used in treating SLAC of the wrist include arthroscopic débridement, denervation, radial styloidectomy, scaphoid excision and four-corner arthrodesis, scaphoid excision and capitolunate arthrodesis, proximal row carpectomy, arthroplasty of the wrist, and total wrist arthrodesis, or a combination of these procedures. Controversy persists about the relative merits of proximal row carpectomy versus four-corner arthrodesis, and about whether carpectomy of the proximal row may be performed in the setting of capitolunate arthritis.

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