Definition
Scapho-lunate advanced collapse
- scapholunate disruption with flexion of scaphoid
- radioscaphoid arthritis with preservation of radiolunate joint
- descent of capitate into gap and progressive arthritic change
Most common cause of wrist OA
Watson and Ballet classification
Stage 1: Radial styloid / distal pole scaphoid degeneration
Stage 2: Radio-scaphoid degeneration
Stage 3: Capito-lunate degeneration
Stage 4: Pan carpal OA
| Stage 1 | Stage 2 |
|---|---|
|
Radial styloid OA
|
Radio-scaphoid OA |
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|
| Stage 3 | Stage 4 |
|---|---|
|
Capito-lunate OA
|
Pan carpal OA |
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|
Differential diagnosis
SNAC
- scaphoid nonunion
- preservation of scaphoid fossa
- arthritis at scapho-capitate joint
Operative management
Options
Radial styloidectomy - stage 1
Proximal row carpectomy (PRC) - stage 1 / 2
Scaphoidectomy + limited arthrodesis - stage 1 / 2/ 3
Wrist arthrodesis - Stage 4
Results
Amer et al Ann Plast Surg 2020
- systematic review of proximal row carpectomy v four corner arthrodesis for SLAC wrist
- 8 studies and 300 patients
- slightly better outcomes with proximal row carpectomy
Scaphoidectomy & limited arthrodesis
Indication
Stage 1 / 2 / 3
Concept scaphoidectomy + limited arthrodesis
| 4 corner fusion | 4 corner / bi-column | 3 corner fusion | 2 corner fusion |
|---|---|---|---|
|
Capitate - lunate Triquetrum-hamate-capitate
|
Capitate-lunate Triquetrum-hamate |
Capitate - lunate Capitate - hamate +/- triquetrum excision |
Capitate - lunate |
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 |
 |
 |
Two versus four corner fusion
Schriever et al J Hand Surg Eur 2024
- RCT of lunate-capitate fusion versus four corner fusion
- 64 patients with SNAC / SLAC wrist
- at 12 months no difference in outcomes
Hundepool et al J Hand Surg Am 2025
- systematic review of 80 articles and 2000 patients
- two versus three versus four corner fusion
- similar outcomes
- two corner fusion better ROM
- nonunion two corner fusion: 10%
- nonunion four corner fusion: 7%
Fixation options
K wires
Headless compression screws
Dorsal locking plates
Staples
4 corner fusion techniques
| 4 corner | Bi-column |
|---|---|
|
Capitate / lunate screw + Triquetrum / hamate / capitate screw |
Capitate / lunate screw + Triquetrum / hamate screw |
|
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Vumedi scaphoidectomy and four corner fusion with screws
Arthrex scaphoidectomy and four corner fusion with staples
Acumed four corner fusion plate surgical technique PDF
2 corner fusion techniques / capito-lunate fusion
Vumedi scaphoidectomy and capito-lunate fusion video
Proximal row carpectomy
Concept
Remove scaphoid / lunate / triquetrum
Allow capitate to articulate with lunate fossa of the radius
Indication
Stage 2: preserved capitate
Stage 3: consider adding capitate resurfacing
Technique
Vumedi dorsal approach PRC video
Results
- systematic review of PRC +/- capitate resurfacing
- 1700 PRC v 80 PRC + capitate resurfacing
- at one year better outcomes with addition of capitate resurfacing
Wrist arthrodesis
Indications
End stage disease
Manual worker
www.boneschool.com/wrist-arthrodesis
