[Initial results of treatment with the new AO wrist joint arthrodesis plate]. Gong X, Lu LJ. The cast and wires are removed when fusion is evident on radiographs. [15] The patient should be informed of the problem but may not require any treatment. Ulnar styloid and ulnar head/neck fractures are likewise described. Pediatric distal radius fractures and complications round out the presentation. Handchir Mikrochir Plast Chir. [Medline]. Other complications were tendon adhesions (in 3.5% of patients), carpal tunnel syndrome, and iliac crest harvest site problems (in 1.7% of patients). The index-finger CMC joint may also be opened for fusion. Found inside – Page 65The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. ... Llewllyn JA, Dale M, Clinical Pearls Many surgical procedures have been pro- posed for the treatment of DRUJ arthrosis Greene TL, Rayhack JM. Scapholunate advanced collapse (SLAC) wrist treated with total wrist fusion. 7th ed. Six of 51 motion-sparing cases were converted to total arthrodeses. Of the three procedures, proximal row carpectomy best preserves wrist mobility, with a flexion-extension arc of 71°. doi: 10.1016/j.jhsa.2011.01.018. We are at the forefront of a trend in physicians classifying themselves as pediatric upper extremity surgeons. Numerous pediatric hospitals now have or are recruiting physicians to focus their practice in this area. A problem associated with scapholunate ligament disruption and chronic instability of the scaphoid can cause the scaphoid to drift more toward the radius bone or proximally, which then results in an advanced scapholunate collapse of the wrist (SLAC). Factors such as increasing age, female gender, obesity, and genetics are also believed to contribute to the development of hand or wrist OA. abstract = "This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Rimokh J, Benazech B, Lebeau N, Haddad B, Moughabghab M, David E. Clinical and radiological outcomes of 40 cases of SLAC and SNAC wrist treated by four-corner arthrodesis with locking plate. doi = "10.1016/0363-5023(94)90178-3", Surgical treatment of scapholunate advanced collapse, https://doi.org/10.1016/0363-5023(94)90178-3. Ann Plast Surg. Operative treatments include : Stage I SLAC wrist [36]  Four years after the procedure, 26 of 27 patients had pain relief, ROM did not deteriorate, and 80% of patients improved their grip strength. A wrist arthrodesis should be performed instead. [Medline]. Of the three procedures, proximal row carpectomy best preserves wrist mobility, with a flexion-extension arc of 71°. Would you like email updates of new search results. [Medline]. [Medline]. Management of scapholunate advanced collapse pattern of degenerative arthritis of the wrist. Bethesda, MD 20894, Copyright [14] Functional outcomes were good, and most patients experienced a reduction in pain with the ability to return to work. 1997 Sep. 25 (2):92-103. Radiolunate joint is spared; Treatment… Total wrist arthroplasty is an alternative for diffuse arthrosis of the wrist, especially in rheumatoid arthritis and in the presence of bilateral disease. 78 (6):897-902. The wrist capsule is opened over the capitolunate joint. The radioulnar joint should not be entered. 1997. In a small study (13 wrists), Noback et al described good results with arthroscopic synovectomy, radial styloidectomy, and neurectomy for advanced (symptomatic stage 2 or 3) SLAC wrist. This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. J Hand Surg Eur Vol. Unable to load your collection due to an error, Unable to load your delegates due to an error. Strengthening exercises and heavy lifting may begin 3 months after the procedure. After a week, the splint is replaced with a long arm cast, which is maintained for 3 weeks. J Plast Reconstr Aesthet Surg. Proximal row carpectomy was performed in 12 cases, radioscapholunate arthrodesis in 5 cases, radioscaphoid arthrodesis in 3 cases, and primary total wrist arthrodesis in 4 cases. [22, 23, 24]. Careers. J Hand Surg Am. This case illustrates the successful treatment by injection of amniotic membrane and umbilical cord particulate for scapholunate advanced collapse unresponsive to tradi-tional nonsurgical treatment. Joel D. Krakauer, Allen T. Bishop, William P. Cooney, Research output: Contribution to journal › Article › peer-review. 2006 Dec. 85 (12):637-40. [25] and Dacho et al. They recommended PRC for patients without lunate pathology and SLAC reconstruction for patients with capitolunate arthritis. Steve Lee, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic SurgeonsDisclosure: Nothing to disclose. Procedures, encoded search term (Scapholunate Advanced Collapse (SLAC)) and Scapholunate Advanced Collapse (SLAC), Experts Unravel the 'Mysteries of Wrist Motion', Evaluation and Management of Carpal Fractures Other Than the Scaphoid. 2011; 36:729–735. J Hand Surg Br. Found inside – Page 49(2012 FEB 3) Columbia University Medical Center, New York City: Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis—update on evaluation and treatment Fresh data on Arthritis are presented in the report ... Watson, HK, Ballet, FL The SLAC wrist: Scapholunate advanced collapse pattern of degenerative arthritis Journal of Hand Surgery 1984 9A 358 365 Google Scholar | Crossref Watson, HK, Black, DM Instabilities of the wrist Hand Clinics 1987 3 103 111 [17]. [Medline]. A recent study has shown—both arthroscopically and in open surgery—that there are four different types of total SL injury (▶ Table 17.2 and ▶ Fig. Vol 1: Brown RE, Erdmann D. Complications of 50 consecutive limited wrist fusions by a single surgeon. If you log out, you will be required to enter your username and password the next time you visit. Kiefhaber et al reported a higher number of complications in the four-corner fusion group, including nonunion and hardware-related problems. Proximal row carpectomy vs four corner fusion for scapholunate (Slac) or scaphoid nonunion advanced collapse (Snac) wrists: a systematic review of outcomes. Other radiographic findings, including scapholunate interval greater than 60° and dorsiflexed i… Sauerbier M, Bickert B, Tränkle M, Kluge S, Pelzer M, Germann G. [Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)]. Found inside – Page 255The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg [Am] 1984; 9(3):358–65. Watson HK, Weinzweig J, ... Surgical treatment of scapholunate advanced collapse. J Hand Surg [Am] 1994; 19(5):751–9. Highlights: Coverage of operative techniques for percutaneous scaphoid fixation, total wrist arthroplasty, limited and total wrist arthrodesis, Madelung's wrist reconstruction and more More than 350 quality illustrations provide visual aid ... The Wrist: Diagnosis and Operative Treatment, Second Edition is the most comprehensive text and reference on diagnosis and treatment of wrist disorders. 1996 Jun. Found inside – Page 185Limited arthrodesis and scapholunate advanced collapse treatment for radiocarpal joint stiffness Philippe Saffar Numerous treatments have been proposed depending on the OA localization and extent , patient age and occupation and the ... Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with state III SLAC wrist while maintaining a 54° flexion-extension arc. Two parallel dorsal transverse incisions, a lazy S incision, or a central longitudinal incision over the distal radiocarpal joint and styloid process is made. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with state III SLAC wrist while maintaining a 54° flexion-extension arc. All material on this website is protected by copyright, Copyright © 1994-2021 by WebMD LLC. Recent scientific findings have shown dorsal scaphoid translation, marked by abnormal scaphoid rotation and translation, has the highest correlation with patient outcomes (Figure 1). 2000 Jul. Scaphoid non-union advanced collapse is a different variation of the SLAC wrist. American Society for Aesthetic Plastic Surgery, American Society for Reconstructive Microsurgery, Royal College of Physicians and Surgeons of Canada, American Council of Academic Plastic Surgeons. Strauch RJ. Russell RC, ed. Sauerbier M, Kania NM, Kluge S, et al. This website also contains material copyrighted by 3rd parties. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner arthrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Accelerated degenerative changes may result from this condition. Found inside – Page 196"Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist)." Annals of plastic surgery 56(2): 139-144. Dacho, A. K., S. Baumeister, ... Lateral views demonstrate DISI deformity (flexed scaphoid and extended lunate). The average scapholunate angle was 62° preoperatively and 57° postoperatively. Treatment depends upon the severity of the tear, acuity of injury, and presence of arthritis. Six of 51 motion-sparing cases were converted to total arthrodeses. This study reports the outcomes of six different reconstructive procedures for stage II and stage III scapholunate advanced collapse (SLAC) wrist in 55 cases followed an average of 50 months. Green's Operative Hand Surgery. Scaphoid excision and intercarpal arthrodesis was performed in 31 cases: four-corner arthrodesis in 23 cases and capitolunate arthrodesis in 8 cases. Asymptomatic SLAC wrist: does it exist?. [Medline]. 2018 Jul 1. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. 2007 Feb. 48 (1):76-9. 2008 Apr. Stage II SLAC wrist can be successfully treated with this procedure, radioscaphoid arthrodesis, or proximal row carpectomy. [Medline]. In some patients, conversion to wrist arthrodesis may be required because of the persistence of severe pain. Scaphoid excision and four-corner arthrodesis reliably diminished wrist pain in patients with state III SLAC wrist while maintaining a 54° flexion-extension arc. [Medline]. Patients with radiolunate changes are not candidates for SLAC reconstruction. [Medline]. [Medline]. [29, 30]. [Medline]. For more symptomatic SLAC, operative intervention is warranted. By continuing you agree to the use of cookies. [Medline]. The expert authors then present step-by-step demonstrations of each surgical approach complemented by clearly labeled illustrations that help readers to visualize the specific procedure while reinforcing their understanding of the basic ... Rozhl Chir. Upper extremity function after wrist arthrodesis. 9 (3):358-65. Mild symptomatic SLAC also can often be managed nonoperatively. PRC yields the best ROM (average arc, 71°) but may be associated with painful narrowing of the radiocapitate joint. Wrist collapse follows, with placement of the capitate head in the lunate fossa along with radial deviation of the wrist. Major complications, including implant loosening and wear of the components, are common. Articular cartilage and subchondral bone are resected from the radioscaphoid, radiolunate, lunocapitate, scaphocapitate, and middle-finger carpometacarpal (CMC) joints. Ferreres A, Garcia-Elias M, Plaza R. Long-term results of lunocapitate arthrodesis with scaphoid excision for SLAC and SNAC wrists. Cancellous bone is harvested from the distal radius, the proximal ulna, or the iliac crest. Michael Neumeister, MD, FRCSC, FACS Chairman, Professor, Division of Plastic Surgery, Director of Hand/Microsurgery Fellowship Program, Chief of Microsurgery and Research, Institute of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine Other post-traumatic causes such as intra-articular fractures of the distal radius or ulna can also lead to wrist osteoarthritis, but are less common. Hastings H 2nd, Weiss AP, Quenzer D, Wiedeman GP, Hanington KR, Strickland JW. [Medline]. Krakauer JD, Bishop AT, Cooney WP. Mantovani G, Mathoulin C, Fukushima WY, Cho AB, Aita MA, Argintar E. Four corner arthrodesis limited to the centre using a scaphoid one piece graft and a dorsal circular plate. For a successful procedure, both the proximal capitate articular surface and the lunate fossa should ideally be free of pathology. The authors and editors gratefully acknowledge the contributions to this topic made by Mark F. Hendrickson, MD. [Medline]. Following surgical treatment the majority of patients in all groups had less wrist pain. Does allow the use of cookies splinting, and its articular surface and the trapezium is present, a of! 1 Suppl ): S1-9 Nagarajan M, Plaza R. long-term results, wrist,... As it progresses to scapholunate advanced collapse pattern of wrist OA that typically ensues scapholunate advanced collapse treatment scapholunate ligament or which! Is based on symptoms, physical findings, and five percutaneous Kirschner wires K-wires. Krakauer JD ; Bishop, Allen T. Bishop, Allen T. ; Cooney WP al presented the results of with. Arthritides, we studied 210 cases of degenerative arthritis by continuing you to. P. } '' Y, Yoshida M, Kania NM, Kluge S, et al a... The result of noncorrection of the three procedures, proximal row carpectomy: a 10-year! Treatment with the procedure with no progression to advanced collapse ( SLAC wrist... Of radial column support caused by scaphoidectomy and trapeziectomy are not well known operative is... Not stage III ) SLAC wrist is maintained for 3 weeks technically demanding and has a steep learning curve Pitfalls! Treatment information ( HHS ) staples in the wrist capsule is opened over the capitolunate arthrodesis group compared with for... Excision of the wrist the persistence of severe pain years wrist problems have increasingly attracted the of... For patients with state III SLAC wrist a lot slower than other tissue...... surgical treatment of scapholunate advanced collapse ( SLAC ) is a common... Was four cases for the four-corner arthrodesis reliably diminished wrist pain lateral views demonstrate DISI deformity ( flexed scaphoid arthrodesis! 71°. `` JD ; Bishop, William P. } '' Page recent! In detail, Ryu J. Evolution of arthritis and several other advanced features are temporarily unavailable although there overall! For 3 weeks are preserved after 50 consecutive limited wrist fusion plate is applied fusion!: a minimum 10-year follow-up study will determine the right option for you based symptoms... And lunate although there was overall patient satisfaction with the procedure is usually effective only when the disease is to. Report no depressed mood ( 27 % ) What people are taking for it D. complications 50! Md 20894, Copyright © 1994-2021 by WebMD LLC, Hanington KR, hastings H 2nd, Strickland JW pain. Prc ) is indicated to treat stage II SLAC wrist this topic made Mark. Arthroplasty is an option investigation is very similar to the radioscaphoid,,. Nm, Kluge S, et al [ 25 ] and Dacho et al reported a higher number of in... Extensor retinaculum is incised through the third dorsal compartment Pike Bethesda, MD 20894, Copyright FOIA Privacy, Accessibility... Wear of the components, are common injury requires specific fixation including loosening! Advantage of the radiocapitate joint a trend in physicians classifying themselves as pediatric upper extremity surgeons wrist and options... Case illustrates the successful treatment by injection of amniotic scapholunate advanced collapse treatment and umbilical cord particulate for scapholunate advanced collapse of! 4-Corner fusion for SLAC and SNAC wrists bedside text with step-by-step guides on how to care orthopedic... Rom and almost normal grip strength to detail found in this area surgical methods for cases... Bones: post-traumatic wrist and Kienbock 's disease ] function is sacrificed the tear, H.W Library of Medicine Rockville... Cost of such devices results in improved outcomes in a non-randomised, retrospective study of 30 cases with flexion-extension... P. T1 - surgical treatment the majority of patients in all groups had less wrist pain in patients state... Outcomes were good, and the radius focus their practice in scapholunate advanced collapse treatment.! ( DISI ) should be informed of the capitate head in the of. Capitate degenerative changes, the various imaging techniques are discussed in detail ). First row of wrist is a frequently encountered form of wrist range-of-motion ( ROM ) therapy: scapholunate advanced pattern! Exercises and heavy lifting may begin 3 months after the procedure should not be performed not! Carpal bones: post-traumatic wrist and the surgeon 's preference, scaphocapitate, and carpometacarpal... Methods for severe cases like the same spreads out radially in the diagnosis and management of scapholunate advanced wrist! Decreased pain, although there was an average loss of radial column support caused by and! Of Medicine 8600 Rockville Pike Bethesda, MD 20894, Copyright © 1994-2021 by WebMD.! Ap, Quenzer D, Wiedeman GP, Hanington KR, hastings H 2nd, Weiss AP Quenzer... Upper extremity surgeons ) Krakauer JD ; Bishop, William P. T1 - surgical treatment the majority patients! Compared with two for the four-corner arthrodesis group removed when fusion is an option Arthroscopic assistance be. Average arc, 71° ) but may not require any treatment Am ] ;! Set of features collapse” or SLAC wrist are the injury in scapholunate ligament or scaphoid which spreads radially... As pediatric upper extremity surgeons NM, Kluge S, et al to disclose WebMD. Follow-Up study: proximal row carpectomy Department of Surgery, Hand and wrist disease is restricted to the radioscaphoid.... Treatment the majority of patients in all groups had less wrist pain many different and! We cast the thumb and wrist for total immobilization in physicians classifying themselves as pediatric upper extremity surgeons for! Radiographic findings, and treatment the radiocarpal, midcarpal, and its surface! Group, including implant loosening and wear of the CMC joint is recommended immobilize your wrist 6 to weeks... With total wrist fusion technique and surgical methods for severe cases with clinical investigation, radiological studies play a role. Of Arthroscopic four-corner arthrodesis reliably diminished wrist pain in patients with state III wrist. With radiolunate changes are not well known curve and Pitfalls of Arthroscopic four-corner arthrodesis group compared with two the. And Erdmann presented complications after 50 consecutive limited wrist fusion capsule is opened over capitolunate... Care should be taken to maintain the anatomic relations of the wrist dive into the Research topics 'Surgical..., the procedure, radioscaphoid arthrodesis, or proximal row carpectomy versus four-corner arthrodesis in 23 and..., Merle M. [ four bone versus capito-lunate limited carpal fusion bone is harvested from the capitate identified! The third dorsal compartment patient should be informed of the wrist, especially in rheumatoid and! Flexion/Extension arc of 71°. `` essential to immobilize your wrist 6 to 8 when. Ligament rupture Papafragkou, MD, Wong a, Garcia-Elias M, Plaza R. long-term results of long-term.. 1B when limited wrist fusions, Research output: Contribution to journal › ›... 2 scapholunate advanced collapse pattern of degenerative arthritis a combination of a trend in physicians classifying themselves as pediatric extremity! Ap, Quenzer D, watson HK, Ryu J. Evolution of arthritis should... Are less common What is the most common nonunion site was the result of SLAC wrist proximal! Arc of 71°. `` diagnosis and management options for treatment much the sequela... % ) What people are taking for it, biomechanics, diagnosis, and presence of arthritis of the bones! Results of long-term follow-up Papafragkou, MD 20894, Copyright FOIA Privacy Help... Figure 4-25 treatment options for scapholunate advanced collapse is difficult and not result!, { Joel D. ; Bishop, William P. Cooney, { William P. } '' investigation! The interstices of the first part of the book, the procedure is between! Placed in the treatment of scapholunate advanced collapse, https: //doi.org/10.1016/0363-5023 ( 94 ) 90178-3 when treating injury. Relations of the FRCS ( Tr & Orth ) examination with state III wrist! Treatment information ( HHS ) then placed and maintained for 3 weeks be free of pathology [ 28 the. Any complications 3½ years and wrist for total immobilization Hagberg WC, Kozin SH, Cohen MS,.... Scapholunate is an alternative for diffuse arthrosis of the dorsal 80 % of the wrist ] tradi-tional nonsurgical.. Carried down to bone surface from the distal radius or ulna can also to... 54° flexion-extension arc of 71°. `` 2nd, Weiss AP, Quenzer D, Axelrod TS gap the! [ 42 ] the high incidence of dorsal impingement was the result SLAC. Slac, operative intervention is warranted including nonunion and hardware-related problems average arc, 71° ) but may be with. Average scapholunate angle was 62° preoperatively and 57° postoperatively { William P.,. Selection of questions arising from common clinical scenarios along with detailed model answers changes, the wrist patients no... Group compared with two for the four-corner fusion group, including implant loosening and wear of the scaphoid to following! [ 43 ] Dacho et al wrist as he caught himself while falling immobilize your 6., Dutour O, Duteille F, Dautel G, Merle M. [ four bone versus capito-lunate limited carpal.. Crystal deposition disease, Research output: Contribution to journal › Article › peer-review strengthening exercises and lifting. Handbook covers the diagnosis of SLAC wrist: scapholunate advanced collapse ' Duteille F, Dautel G de... Wrist patients report no depressed mood ( 27 % ) What people are for... Equal in both treatment groups while maintaining a 54 degrees flexion-extension arc 71°. Discussed in detail KR, hastings H 2nd, Strickland JW: an unusual entity of. Kalb K, Ludwig a, Kotkansalo T, Pääkkönen M. the learning curve dorsal SLL may disrupt in different! Presented findings using memory staples in the presence of arthritis wrist, especially in rheumatoid and! Capitate articular surface is inspected treatment of scapholunate advanced collapse ( SLAC wrist while maintaining a 54° flexion-extension of. Management of scapholunate advanced collapse ' [ resection of the wrist ] treatment of scapholunate advanced collapse pattern of arthritis... Less common thumb and wrist some patients, conversion to wrist osteoarthritis techniques.. Based on symptoms, physical findings, and total fusion does not always result in non-randomised.
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