A modified technique of four-bone fusion for advanced carpal collapse (SLAC/SNAC wrist)

This study reports the outcome of 16 patients treated with a modified four-bone fusion for symptomatic stage II and III advanced carpal collapse. The technique is based on fusion of the capitate, lunate, hamate and triquetrum using an autogenous corticocancellous bone-graft fixed with screws. The void left behind after scaphoid excision was filled with an extensor carpi radialis longus anchovy. After an average follow up of 3 years; there were 13 excellent and three good outcomes. In every patient pain relief was achieved with preservation of joint motion and grip strength. All the patients were able to return to their previous activities and jobs. Radiographic evaluation showed bone fusion in all 16 patients with a slight decrease in carpal height but a well preserved radiolunate joint space. In conclusion, this technique provides immediate stable fixation and early mobilization and assures bone fusion.