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

Wrist osteoarthritis can lead to mechanical pain, limitation of ROM and decreased strength, being a significant burden on the patient's life. Our study aims to showcase the results of closed wedge radial osteotomy on SNAC osteoarthritic wrists, a scarcely reported technique in the literature.

14 patients with varied wrist pathology among SNAC and scaphoid nonunion were treated with closed radial wedge osteotomy at the metaphysis. A detailed clinical examination was performed pre- and postoperatively including PRWE, MMWS, VAS score and ROM. The mean radial angulation was also measured on the pre- and postoperative X-rays.

The mean age of our patients was 56.7 ± 9.1. Fourteen patients had SNAC wrist. All patients were treated with radial closed wedge osteotomy at the metaphysis and showed excellent healing at the fracture site. The mean PRWE and MMWS were improved from 85.3 ± 4.8 to 19.7 ± 24.5 and from 15.8 ± 5.2 to 78.2 ± 22.4, respectively. Statistically significant difference was also noted on the VAS score (from 9.2 ± 0.7 to 2.7 ± 2.2) and ROM. The mean radial angulation was reduced from 118.1° ± 1.5° to 107.3° ± 1.9°.

The closing radial wedge osteotomy presented promising results in our case series regarding ROM and pain. The technique could prove a reliable first-line treatment for patients with debilitating wrist osteoarthritis confined to the scaphoid/scapholunate, as it preserves the ligamentous insertions and the bone stock, maintaining the option for more extensive wrist treatments in the future.