Salvage Procedures for the Treatment of Wrists with Scapholunate Advanced Collapse

Abstract

Proximal row carpectomy (PRC) and scaphoid excision with four corner fusion (4CF) are common salvage procedures to preserve motion in wrists with scapholunate advanced collapse (SLAC). A case scenario is presented and the evidence for outcomes provided through the use of a systematic review. We collated 14 articles that examined the outcomes for SLAC patients undergoing PRC or 4CF. Although the lack of unbiased trials must be acknowledged, this systematic review provides best available evidence that both procedures give improvements in pain and subjective outcome for patients with symptomatic SLAC. PRC may provide better postoperative range of motion (ROM) and lacks the potential complications specific to 4CF. The risk of subsequent osteoarthritis is significantly higher in PRC patients despite the majority being asymptomatic at the time of review. Grip strength, pain relief and subjective outcomes are similar in both treatment groups.