Case Series: Distal Closing-Wedge Radial Osteotomy for Scaphoid Nonunion Advanced Collapse (SNAC) Wrists

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Osteoarthritis Treatment

Background:

• Wrist osteoarthritis, including SNAC wrist, causes significant pain, limited range of motion (ROM), and decreased strength.
• Current treatment options for SNAC wrist are limited, with few studies reporting on specific surgical techniques.
• Closed wedge radial osteotomy is a scarcely reported technique for treating SNAC wrist osteoarthritis.

Purpose of the Study:

• To evaluate the clinical outcomes of closed wedge radial osteotomy in patients with SNAC wrist osteoarthritis.
• To assess the efficacy of this technique in improving pain, ROM, and wrist function.
• To determine the feasibility and safety of closed wedge radial osteotomy for SNAC wrist.

Main Methods:

• A case series of 14 patients with SNAC wrist or scaphoid nonunion treated with closed radial wedge osteotomy.
• Pre- and postoperative clinical assessments included Patient-Reported Wrist Evaluation (PRWE), Merrit-Mainland Wrist Score (MMWS), Visual Analog Scale (VAS) for pain, and ROM measurements.
• Radiographic evaluation included measurement of mean radial angulation.

Main Results:

• All 14 patients demonstrated excellent healing of the osteotomy site.
• Significant improvements were observed in PRWE (85.3 to 19.7), MMWS (15.8 to 78.2), VAS score (9.2 to 2.7), and ROM.
• Mean radial angulation decreased from 118.1° to 107.3° postoperatively.

Conclusions:

• Closed wedge radial osteotomy shows promising results for improving ROM and reducing pain in SNAC wrist osteoarthritis.
• This technique may serve as a reliable first-line treatment, preserving bone stock and ligamentous insertions.
• The procedure maintains options for future, more extensive wrist surgeries if needed.