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Isolated scaphoidectomy for type II SLAC and SNAC wrists: retrospective case-series at long-term follow-up
Maurizio Altissimi1,2, Elisabetta Pataia3, Michela Saracco4
1Hand Surgery Unit, Clinical Institute Porta Sole, Perugia, Italy.
Backgrounds:
Stage II scapholunate advanced collapse (SLAC) and Scaphoid non-union advanced collapse (SNAC) wrists are currently treated either by scaphoidectomy and Four Corner Fusion or by Proximal Row Carpectomy. In our retrospective study, isolated scaphoidectomy demonstrated clinical non-inferiority when compared to standard procedures and could be supplemented by a Four Corner Fusion only at a later time if needed.
Methods:
Between 2006 and 2011, 13 patients / 14 wrists (mostly males, manual workers) underwent the surgical procedure. 8 patients were affected by SNAC and 5 by SLAC. The average age was 56,5. All patients were manual workers. The mean follow-up was 15 years. These patients were reviewed a first time in 2012 and once again in 2024. Subjective outcome, DASH score, return to work, ROM and grip strength were evaluated. Radiographic assessment was done in all 14 wrists at the first follow-up and in 6 at the last long-time review. Statistical analysis was conducted using the SPSS software.
Results:
12 patients had resumed the same work at a mean of 3 months after surgery. Only one patient required a Four Corner Fusion after 2 years. 11 of the 13 enrolled patients declared their satisfaction for the procedure at the longest follow-ups. Clinical results remained stable over time. Radiological deterioration was seen in 6/13 wrists at the first follow-up and in all the 6 patients that could be investigated with an X-ray at the second long term follow-up. Lunate-Capitate arthrosis and Lunate DISI pattern were the radiological features observed without carpal collapse.
Conclusion:
Isolated scaphoidectomy for type II SLAC and SNAC wrist is a reliable and simple surgical procedure which could be proposed only after careful patient selection. This procedure has maintained a high level of satisfaction at long-term follow-up despite the radiological deterioration. It is far less invasive and requires a shorter time of functional recovery than Four Corner Fusion and Proximal Row Carpectomy in elderly or low-demanding patients with good pain relief. In case of failure, isolated Scaphoidectomy can be supplemented by a Four Corner Fusion at a later time if needed.
