eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Scapholunate Advanced Collapse: Follow-up

Author: Dimitrios Danikas, MD, Attending Plastic Surgeon, Bayhealth Medical Center
Coauthor(s): Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC; Michael Neumeister, MD, FRCSC, Professor & Chairman - FACS - Director Hand/Microsurgery Fellowship - Division of Plastic Surgery, Southern Illinois University School of Medicine; Richard Brown, MD, FACS, Clinical Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Sep 2, 2008

Outcome and Prognosis

SLAC reconstruction

In a series of 250 procedures, Watson and Weinzweig reported nonunion in 1%, wound infection in 1%, reflex sympathetic dystrophy in 1.5%, and capitate-radial impingement requiring revision arthroplasty in 13%.23 The high incidence of dorsal impingement was the result of noncorrection of the lunate dorsal intercalated segment instability (DISI) deformity. A flexion/extension arc of 60-65° can be expected with a 4-bone fusion. Brown and Erdmann present complications after 50 consecutive limited wrist fusions.24

Proximal row carpectomy

Krakauer et al compared scapholunate advanced collapse (SLAC) reconstruction with proximal row carpectomy (PRC).25 Patients with PRC had 71° of motion, and patients with SLAC reconstruction had 54° of motion. Krakauer et al recommend PRC for patients without lunate pathology and SLAC reconstruction for patients with capitolunate arthritis. Wyrick et al presented similar results and recommendations.26 Total wrist motion was 85° and grip strength 94% in the PRC group. Total wrist motion was 67° and grip strength 74% in the SLAC group. Imbriglia et al presented results of long-term follow-up after proximal-row carpectomy.27 Four years after the procedure, 26 of 27 patients had pain relief, ROM did not deteriorate, and 80% of patients improved their grip strength. PRC appears to offers better ROM and almost normal grip strength. In some patients, conversion to wrist arthrodesis may be required because severe pain persists.

Total wrist arthrodesis

Hastings et al reported a 2% nonunion rate with total wrist fusion.28 The most common nonunion site was the middle finger carpometaphalangeal joint. To prevent this complication, complete decortication of the dorsal 80% of the carpometaphalangeal joint is recommended. Other complications were tendon adhesions (in 3.5% of patients), carpal tunnel syndrome, and iliac crest harvest site problems (in 1.7% of patients). Weiss et al discuss upper extremity function after arthrodesis.29 Dacho et al discuss long-term results.30

Total wrist arthroplasty

Major complications of implant loosening and wear of the components are common.

 
Acknowledgments

The authors and editors gratefully acknowledge the contributions to this topic made by Mark F. Hendrickson, M.D.



More on Scapholunate Advanced Collapse

Overview: Scapholunate Advanced Collapse
Workup: Scapholunate Advanced Collapse
Treatment: Scapholunate Advanced Collapse
Follow-up: Scapholunate Advanced Collapse
Multimedia: Scapholunate Advanced Collapse
References
Further Reading
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References

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  2. Sauerbier M, Bickert B, Trankle M, et al. [Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)]. Unfallchirurg. Jul 2000;103(7):564-71. [Medline].

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  5. Bednar MS, Light TR. Degenerative arthritis. In: Russell RC, ed. Hand Surgery. Vol 4. St Louis, Mo: Mosby; 2000.

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  9. Nagle DJ. Artroscopy. In: Russell RC, ed. Hand Surgery. Vol 4. St Louis, Mo: Mosby; 2000.

  10. Fassler PR, Stern PJ, Kiefhaber TR. Asymptomatic SLAC wrist: does it exist?. J Hand Surg [Am]. Jul 1993;18(4):682-6. [Medline].

  11. Pilný J, Kubes J, Hoza P, Sprláková A, Hart R. [Consequennce of nontreatment scapholunate instability of the wrist]. Rozhl Chir. Dec 2006;85(12):637-40. [Medline].

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  13. Garcia-Lopez A, Perez-Ubeda MJ, Marco F, et al. A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist). J Hand Surg [Br]. Aug 2001;26(4):352-4. [Medline].

  14. Tomaino MM, Miller RJ, Cole I, Burton RI. Scapholunate advanced collapse wrist: proximal row carpectomy or limited wrist arthrodesis with scaphoid excision?. J Hand Surg [Am]. Jan 1994;19(1):134-42. [Medline].

  15. Welby F, Alnot JY. [Resection of the first row of carpal bones: post-traumatic wrist and Kienbock''s disease]. Chir Main. Jun 2003;22(3):148-53. [Medline].

  16. Vanhove W, De Vil J, Van Seymortier P, Boone B, Verdonk R. Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist. J Hand Surg Eur Vol. Apr 2008;33(2):118-25. [Medline].

  17. Dacho AK, Baumeister S, Germann G, Sauerbier M. Comparison of proximal row carpectomy and midcarpal arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC-wrist) and scapholunate advanced collapse (SLAC-wrist) in stage II. J Plast Reconstr Aesthet Surg. Oct 19 2007;[Medline].

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  20. Kalb K, Ludwig A, Tauscher A, et al. [Treatment outcome after surgical arthrodesis]. Handchir Mikrochir Plast Chir. Jul 1999;31(4):253-9. [Medline].

  21. Ekelund L, Hagberg L, Hörberg L, Jörgsholm P, Gunnarsson M. Imaging of four-corner fusion (SLAC arthrodesis) of the wrist with 64-slice computed tomography. Acta Radiol. Feb 2007;48(1):76-9. [Medline].

  22. Masmejean E, Dutour O, Touam C, Oberlin C. [Bilateral SLAC (scapholunate advanced collapse) wrist: an unusual entity. Apropos of a 7000-year-old prehistoric case]. Ann Chir Main Memb Super. 1997;16(3):207-14. [Medline].

  23. Watson HK, Weinzweig J. Intercarpal arthrodesis. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green's Operative Hand Surgery. Vol 1. Philadelphia, Pa: Churchill Livingstone; 1999.

  24. Brown RE, Erdmann D. Complications of 50 consecutive limited wrist fusions by a single surgeon. Ann Plast Surg. Jul 1995;35(1):46-53. [Medline].

  25. Krakauer JD, Bishop AT, Cooney WP. Surgical treatment of scapholunate advanced collapse. J Hand Surg [Am]. Sep 1994;19(5):751-9. [Medline].

  26. Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg [Am]. Nov 1995;20(6):965-70. [Medline].

  27. Imbriglia JE, Broudy AS, Hagberg WC, McKernan D. Proximal row carpectomy: clinical evaluation. J Hand Surg [Am]. May 1990;15(3):426-30. [Medline].

  28. Hastings H 2nd, Weiss AP, Quenzer D, et al. Arthrodesis of the wrist for post-traumatic disorders. J Bone Joint Surg Am. Jun 1996;78(6):897-902. [Medline].

  29. Weiss AC, Wiedeman G Jr, Quenzer D, et al. Upper extremity function after wrist arthrodesis. J Hand Surg [Am]. Sep 1995;20(5):813-7. [Medline].

  30. Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg. Feb 2006;56(2):139-44. [Medline].

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Further Reading

Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Work Loss Data Institute.  2004 (revised 2007 May 16).  80 pages. [NGC Update Pending] NGC:005799
 
Chronic wrist pain.
American College of Radiology.  1998 (revised 2005).  7 pages.  NGC:004619
 
Acute hand and wrist trauma.
American College of Radiology - Medical Specialty Society.  1998 (revised 2005).  8 pages.  NGC:004607

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Keywords

scapholunate advanced collapse, SLAC wrist, degenerative arthritis, scaphoid injury, scapholunate collapse, scapholunate dissociation, wrist pain, carpal tunnel syndrome, carpal ligament instability,  scaphoid fracture, wrist arthritis, arthritis of the wrist, wrist arthrodesis, periscaphoid arthritis, scaphoid nonunion advanced collapse, SNAC, Terry Thomas sign, carpal bone, scaphoid, lunate, hand bone, os lunatum, os scaphoideum, perilunate fracture dislocations, perilunate injuries

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Contributor Information and Disclosures

Author

Dimitrios Danikas, MD, Attending Plastic Surgeon, Bayhealth Medical Center
Dimitrios Danikas, MD is a member of the following medical societies: American Academy of Anti-Aging Medicine, American College of Surgeons, and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Steve Lee, MD, Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC
Steve Lee, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Michael Neumeister, MD, FRCSC, Professor & Chairman - FACS - Director Hand/Microsurgery Fellowship - Division of Plastic Surgery, Southern Illinois University School of Medicine
Michael Neumeister, MD, FRCSC is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, American Society of Plastic Surgeons, Association of Academic Chairmen of Plastic Surgery, Canadian Society of Plastic Surgeons, Illinois State Medical Society, Illinois State Medical Society, Ontario Medical Association, Plastic Surgery Research Council, Royal College of Physicians and Surgeons of Canada, and Society of University Surgeons
Disclosure: Nothing to disclose.

Richard Brown, MD, FACS, Clinical Professor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael Yaszemski, MD, PhD, Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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