Stage III Advanced Wrist Collapse Treatment Options: A Cadaveric Study

Area of Science:

• Orthopedic surgery
• Hand and wrist biomechanics
• Cadaveric study

Background:

• Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) significantly impact wrist function and patient quality of life.
• Current treatments aim for satisfactory outcomes, but restoring physiological wrist motion remains a challenge.

Purpose of the Study:

• To compare wrist mobility and alignment after four treatments for grade III wrist collapse.
• Treatments evaluated: no treatment, scaphoidectomy with lunate-capitate arthrodesis, scaphoidectomy with two-column arthrodesis, and scaphoidectomy with one-column arthrodesis plus triquetrum excision.

Main Methods:

• Utilized four paired fresh-frozen human cadaveric upper limbs (n=8).
• Computed tomography (CT) scans were performed at various testing states.
• Evaluated midcarpal joint mobility and carpal alignment.

Main Results:

• All surgical treatments resulted in a significant decrease in wrist extension.
• No significant differences in carpal alignment or mobility were found between middle column (one-column) and two-column arthrodesis.
• Triquetrum excision notably improved ulnar deviation compared to other fusion methods.

Conclusions:

• One-column arthrodesis (scaphoidectomy, lunate-capitate arthrodesis) provides comparable carpal alignment and range of motion to bi-column arthrodesis.
• Isolated lunate-capitate arthrodesis with scaphoidectomy may be sufficient for treating stage III advanced wrist collapse.
• Fusion of additional carpal bones may not be necessary, preserving more natural wrist biomechanics.