Surgical management and imaging evaluation of post-traumatic periscaphoid osteoarthritis (SLAC and SNAC wrists)

An untreated scapholunate interosseous ligament injury or scaphoid nonunion leads to progressive post-traumatic periscaphoid osteoarthritis and carpal collapse. Symptomatic forms, known as scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC), are common and disabling, requiring surgical management. Numerous operative options exist depending on the stage of collapse and the extent of joint involvement. We apply a modified Watson radiological classification consisting of four stages of pancarpal collapse, integrating the etiological origin (SLAC or SNAC) and the arthritic progression pattern. This review summarizes current surgical principles for each stage of the disease and highlights the key role of imaging in postoperative assessment. Radiography remains the first-line tool to evaluate carpal alignment and implant positioning. CT and CBCT provide high-resolution analysis of bony structures and fixation devices, while ultrasound enables dynamic evaluation of superficial soft tissues and implant-tendon relationships without metallic artifacts. MRI, despite its sensitivity for soft tissues and bone marrow, remains limited by metal-induced distortion. A comprehensive understanding of surgical techniques, biomechanical principles, and implant types is essential to accurately interpret postoperative outcomes and detect complications early.