Scaphoid Lunate Advanced Collapse Surgery

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Evolution of Scaphoid Lunate Advanced Collapse Surgery

Operative treatment for SLAC wrist is dependent on how far the osteoarthritis has progressed. In early cases, the damaged ligament between the scaphoid and lunate can be recreated and the end of the radius can be resected to allow for less contact pressures, hopefully slowing of the arthritic process. Sometimes the nerves suppling the pain sensation, such as the anterior and posterior interosseous nerves (AIN and PIN), can be resected to decrease the pain in the wrist from the osteoarthritis.

If the osteoarthritis does not involve the articulation between the lunate and capitate bones and the ligament between the radius, scaphoid and capitate is still intact, then a proximal row carpectomy can be performed. This procedure involves removing scaphoid, lunate and triquetrum, enabling the more distal row of bones in the hand to articulate at the wrist.

When the SLAC wrist has progressed to involve the cartilage between the lunate and capitate, then a scaphoidectomy and four corner fusion is indicated. This procedure removes the scaphoid and then forms a fused conglomeration between the lunate, triquetrum, capitate and hamate bones in the hand. This new fused bone can move as a single unit at the wrist and the previous pain caused by osteoarthritis between these bones is eliminated.

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