The paper concisely covers the history and definition of scapholunate advanced collapse (SLAC) wrist. The treatments options are described in broad terms and referenced. Forty patients’ records are assessed retrospectively; their data having been collected prospectively in a structured and systematic fashion with a minimum follow-up of 10 years. Datasets presented are preoperative status, and 5 and 10 years post surgery. Assessments are subjective and objective: visual analogue pain scores; Disability of Arm, Shoulder and Hand (DASH); active Range of Motion; grip strength; the modified Mayo Wrist Score; and radiological assessment of bony union and evidence of radiolunate arthritis. Results show improvement across all fields from preoperative status to assessment at five years, with the exception of loss of active flexion / extension and radial deviation. These benefits remain stable from 5 to 10 years. Grip strength improved statistically preoperative to five years, and 5 to 10 years. Mild arthritic changes of the radiolunate joint were noted in two patients at seven years. This paper presents the surgical options available for end stage SLAC wrist. The medium term outcomes achieved by other authors are shown to be maintained out to ten years. The paper is a retrospective cohort study utilising a single surgeon’s data. A small number of patient records were not available and a number of exclusions were applied to patients, positively biasing the patient group. Patients with complications or requiring revisional surgery (n=2) were also excluded. The paper does show that the procedure is motion-sparing, and benefits last to at least 10 years, with little evidence of radiolunate arthritis from altered load bearing dynamics.
Do the benefits of scaphoidectomy and four-corner fusion for SLAC last?
Reviewed by Stuart Hamilton
Clinical and radiological outcomes of scaphoidectomy and 4-Corner fusion in scapholunate advanced collapse at 5 and 10 years.
