The Motec cementless modular metal-on-metal ball-and-socket wrist arthroplasty was implanted in 16 wrists with scaphoid nonunion advanced collapse (SNAC; grades 3 or 4) and 14 wrists with scapholunate advanced collapse (SLAC) in 30 patients (20 men) with severe (grades 3 or 4) post-traumatic osteoarthritis of the wrist. The mean age of the patients was 52 years (31 to 71). All prostheses integrated well radiologically. At a mean follow-up of 3.2 years (1.1 to 6.1) no luxation or implant breakage occurred. Two wrists were converted to an arthrodesis for persistent pain. Loosening occurred in one further wrist at five years post-operatively. The remainder demonstrated close bone–implant contact. The clinical results were good, with markedly decreased Disabilities of the Arm Shoulder and Hand (DASH) and pain scores, and increased movement and grip strength. No patient used analgesics and most had returned to work.

Good short-term function was achieved using this wrist arthroplasty in a high-demand group of patients with post-traumatic osteoarthritis.

The August 2023 Wrist & Hand Roundup360 looks at: Complications and patient-reported outcomes after trapeziectomy with a Weilby sling: a cohort study; Swelling, stiffness, and dysfunction following proximal interphalangeal joint sprains; Utility of preoperative MRI for assessing proximal fragment vascularity in scaphoid nonunion; Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review; The position of the median nerve in relation to the palmaris longus tendon at the wrist: a study of 784 MR images; Basal fractures of the ulnar styloid? A randomized controlled trial; Proximal row carpectomy versus four-corner arthrodesis in SLAC and SNAC wrist; Managing cold intolerance after hand injury: a systematic review

The August 2024 Wrist & Hand Roundup. 360. looks at: Methotrexate shows potential in reducing pain for hand osteoarthritis with synovitis; Circumferential casting versus plaster splinting in adult distal radius fractures: the CAST study findings; Surgery shows superior long-term success for Dupuytren contracture compared to needle fasciotomy and collagenase injection; Evolving trends in surgical management of wrist arthritis: a decade-long national analysis; Mid-term outcomes of three commonly used surgical reconstructions for scapholunate instability; SLAC and SNAC: what is the evidence for treatment?; Steroids for trapeziometacarpal osteoarthritis?; When is it safe to return to driving after distal radius fracture fixation? A prospective study

The June 2024 Wrist & Hand Roundup. 360. looks at: One-year outcomes of the anatomical front and back reconstruction for scapholunate dissociation; Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist: results after 3.5 years; Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex; The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study; Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?; Provision of a home-based video-assisted therapy programme in thumb carpometacarpal arthroplasty; Is replantation associated with better hand function after traumatic hand amputation than after revision amputation?; Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: a systematic review

The primary aim of this study was to identify the rate of osteoarthritis in scaphoid fracture non-union. We also aimed to investigate whether the incidence of osteoarthritis correlates with the duration of non-union(interval), and to identify the variables that influence the outcome. We retrospectively reviewed 273 scaphoid fracture non-union presented between 2007 and 2016. Data included patient demographics, interval, fracture morphology, grade of osteoarthritis (Kellgren-Lawrence) and scaphoid non-union advanced collapse (SNAC), and overall health-related quality of life. Patients were divided into two groups (SNAC and Non-SNAC). Group differences were analysed using Mann-Whitney U test and association with Pearson's correlations. A two-sided p-value of <0.05 was considered significant. The scaphoid fracture non-union were confirmed on CT scans (n=243) and plain radiographs (n=35). The subjects were 32 females and 260 males with the mean age of 33.8 years (SD, 13.2). The average interval was 3.1 years (range, 0–45 years). Osteoarthritis occurred in 58% (n=161) of non-unions, and 42% (n=117) had no osteoarthritis. In overall, 38.5% (n=107) had SNAC-1, 9% (n=25) with SNAC-2, and 10.4% (n=29) presented with SNAC-3. The mean interval in the non-SNAC group was 1.2 years, and in SNAC 1,2, and 3 were 2.6, 6.8, and 11.1 years, respectively. The average summary index in SNAC and non- SNAC groups was 0.803 and 0.819, respectively. Our results also showed a significant correlation between advanced osteoarthritis and proximal fracture non-unions(P<0.05). We concluded that there is no clear correlation between the interval and the progression of osteoarthritis. SNAC was more likely to occur in fractures aged 2 years or older

The February 2015 Wrist & Hand Roundup360 looks at: Toes, feet, hands and transfers… FCR Tendonitis after Trapeziectomy and suspension, Motion sparing surgery for SLAC/SNAC wrists under the spotlight, Instability following distal radius fractures, Bilateral wrist arthrodesis a good idea?, Sodium Hyaluronate improves hand recovery following flexor tendon repair, Ultrasound treatments for de Quervain’s, Strategies for treating metacarpal neck fractures

Longstanding un-united scaphoid fractures or scapholunate insufficiency can progress to degenerative wrist osteoarthritis (termed scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC) respectively). Scaphoid excision and partial wrist fusion is a well-established procedure for the surgical treatment of this condition. In this study we present a novel technique and mid-term results, where fusion is reserved for the luno-capitate and triquetro-hamate joints, commonly referred to as bicolumnar fusion. The purpose of this study was to report functional and radiological outcomes in a series of patients who underwent this surgical technique. This was a prospective study of 23 consecutive patients (25 wrists) who underwent a bicolumnar carpal fusion from January 2014 to January 2017 due to a stage 2 or 3 SNAC/SLAC wrist, with a minimum follow-up of one year. In all cases two retrograde cannulated headless compression screws were used for inter-carpal fixation. The clinical assessment consisted of range of motion, grip and pinch strength that were compared with the unaffected contralateral side where possible. Patient-reported outcome measures, including the DASH and PRWE scores were analysed. The radiographic assessment parameters consisted of fusion state and the appearance of the radio-lunate joint space. We also examined the relationship between the capito-lunate fusion angle and wrist range of motion, comparing wrists fused with a capito-lunate angle greater than 20° of extension with wrists fused in a neutral position. The average follow-up was 2.9 years. The mean wrist extension was 41°, flexion 36° and radial-ulnar deviation arc was 43° (70%, 52% and 63% of contralateral side respectively). Grip strength was 40 kg and pinch strength was 8.9 kg, both 93% of contralateral side. Residual pain for activities of daily living was 1.4 (VAS). The mean DASH and PRWE scores were 19±16 and 29±18 respectively. There were three cases of non-union (fusion rate of 88%). Two wrists were converted to total wrist arthroplasty and one partial fusion was revised and healed successfully. Patients with an extended capito-lunate fusion angle trended toward more wrist extension but this did not reach statistical significance (P= 0.07). Wrist flexion did not differ between groups. Radio-lunate joint space narrowing progressed in 2 patients but did not affect their functional outcome. After bicolumnar carpal fusion using retrograde headless screws, patients in this series maintained a functional flexion-extension arc of motion, with grip-pinch strength that was close to normal. These functional outcomes and fusion rates were comparable with standard 4-corner fusion technique. A capito-lunate fusion angle greater than 20° may provide more wrist extension but further investigation is required to establish this effect. This technique has the advantage that compression screws are placed in a retrograde fashion, which does not violate the proximal articular surface of the lunate, preserving the residual load-bearing articulation. Moreover, the hardware is completely contained, with no revision surgery for hardware removal required in this series

The April 2023 Wrist & Hand Roundup³⁶⁰ looks at: MRI-based classification for acute scaphoid injuries: the OxSMART; Deep learning for detection of scaphoid fractures?; Ulnar shortening osteotomy in adolescents; Cost-utility analysis of thumb carpometacarpal resection arthroplasty; Arthritis of the wrist following scaphoid fracture nonunion; Extensor hood injuries in elite boxers; Risk factors for reoperation after flexor tendon repair; Nonoperative versus operative treatment for displaced finger metacarpal shaft fractures.

The February 2023 Wrist & Hand Roundup³⁶⁰ looks at: ‘Self-care’ protocol for minimally displaced distal radius fractures; Treatment strategies for acute Seymour fractures in children and adolescents: including crushed open fractures; Routinely collected outcomes of proximal row carpectomy; Moving minor hand surgeries in the office-based procedure room: a population-based trend analysis; A comparison between robotic-assisted scaphoid screw fixation and a freehand technique for acute scaphoid fracture: a randomized, controlled trial; Factors associated with conversion to surgical release after a steroid injection in patients with a trigger finger; Two modern total wrist arthroplasties: a randomized comparison; Triangular fibrocartilage complex suture repair reliable even in ulnar styloid nonunion.

The April 2024 Wrist & Hand Roundup³⁶⁰ looks at: Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial; Postoperative scaphoid alignment, smoking, and avascular necrosis determine outcomes; Grip strength signals broader health concerns in females with distal radius fractures; Clearing the smoke: how smoking status influences recovery from open carpal tunnel release surgery; Age matters: assessing the likelihood of corrective surgery after distal radius fractures; Is pronator quadratus muscle repair required after anterior plate fixation for distal radius fractures?; Efficacy of total wrist arthroplasty: a comparative analysis of inflammatory and non-inflammatory arthritis outcomes; A comprehensive review of the one-bone forearm as a salvage technique.

Aims

To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour.

Introduction. Isolated midcarpal motion during radioulnar deviation could be approximated to be a rotation in a plane of a radiodorsal/ulnopalmar rotation of the wrist, which may coincide with a motion plane of one of the most essential human wrist motions, known as the dart-throwing motion. This has been studied before in normal volunteers using Magnetic Resonance Imaging to study in vivo kinematics of the midcarpal joint in the wrists of normal volunteers. We present the early results of use of biaxial flexible electrogoniometer to study the range of motion in patients with four-corner fusion. Methods. Ten patients with four-corner fusion for SLAC/SNAC wrist were assessed to study flexion-extension, radial-ulnar deviation, and circumduction motions using flexible electrogoniometers. Opposite unaffected wrist was studied to provide normal data. Angle-angle curves (Lissajous's figures) were generated to study the area under the curve and comparison with the normal wrists and also to study the deviation from the neutral axis. Five normal volunteers were also studied to calculate the area under the curve and the axis of deviation during circumduction of the wrist. Results. The coupling action of mid-carpal motion was revealed as obliquity of the axis of motion with extension combined with radial deviation in normal wrists. This was lost in patients with four-corner fusion as revealed with decrease of obliquity in Lissajous's figures from 19 degrees to 5 degrees. There was 80% reduction in the area in the curve of the figures in comparison to normal wrists (4000 to 960 degree-degrees). Discussion. Electrogoniometer and Lissajous's figures provide a useful method of assessment of range of motion in patients with four-corner fusion. They could be used in future for comparison with patients undergoing limited wrist fusion to study the disability experienced and for counselling regarding the postoperative limitation in activities of daily living experienced by these patients

We studied retrospectively the radiographs of 33 patients with late symptoms after scaphoid nonunion in an attempt to relate the incidence of scaphoid nonunion advanced collapse (SNAC) to the level of the original fracture. We found differing patterns for nonunion at the proximal, middle and distal thirds. The mean intervals between fracture and complaint were 20.9, 6.7 and 12.6 years and obvious degenerative changes occurred in 85.7%, 40.0% and 33.3%, for the six proximal-, eight middle- and two distal-third nonunions, respectively. Nonunion at the proximal and middle thirds showed the first degenerative changes at the radioscaphoid joint, and this was followed by narrowing of the scaphocapitate and then the lunocapitate joints. In our two nonunions of the distal third degenerative changes were seen only at the lunocapitate joint. Most patients with SNAC and nonunion of the middle or distal third showed dorsal intercalated instability; few patients with nonunion of the proximal third developed this deformity. We discuss the initial management of nonunion of the scaphoid at different levels in the light of our findings, and make recommendations

Introduction and purpose: The most commonly found degenerative changes in the wrist can be included in two basic patterns of advanced carpal collapse: On the one hand scapholunate advanced collapse (SLAC) and on the other scaphoid nonunion advanced collapse (SNAC). To treat this collapse, Watson described the so-called four-corner arthrodesis, which includes the lunate, capitate, pisiform and hamate bones. The aim of this study is to assess the results obtained using fixation with a Spider plate. Materials and methods: In this study we included a series of 20 patients that underwent 4-corner arthrodesis with a Spider plate. These cases had stage II or III advanced degeneration of the wrist both SLAC and SNAC. We have also used this technique for other indications such as osteochondral lesions of the head of the capitate, mediocarpal arthritis or mediocarpal instability. Results: Mean follow-up was 16 (7–25) months. An important decrease in pain was seen in all cases and postoperative values were as follows: palmar flexion, 38° (range: 12–46); dorsal flexion, 30° (range: 12–45); radial deviation, 12° (range: 0–16); ulnar deviation, 24° (range: 15–40). An increase in fist force was seen after surgery. The arthrodesis healed in all cases, with a slight decrease in carpal height index after surgery. Conclusions: This surgical technique has allowed us to obtain good results determined clinically and by means of X-rays, as well as early motion after surgery

The December 2022 Wrist & Hand Roundup³⁶⁰ looks at: Anti-tumour necrosis factor therapy for early-stage Dupuytren’s disease; Patient experiences of scaphoid waist fractures and their treatment; Postoperative complications following open a1 pulley release for a trigger finger or thumb; How certain are findings in distal radius fractures: a systematic review of randomized controlled trials; Partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function; Dorsal bridge plating versus bridging external fixation for management of complex distal radius fractures; How is reduction lost in distal radius fractures in females aged 50 years and older; The HAND-Q: psychometrics of a new patient-reported outcome measure for clinical and research applications.

AIM: The scaphoid resection with four-corner fusion is an effective procedure for treatment of postraumatic and degenerative wrist osteoarthritis. Few studies that evaluated the functional and workers compensation results are available in the literature. We presented the results of 4-corner fusion on active heavy labour workers. MATERIAL AND METHODS: A prospective study to evaluate 38 patients (37 male and 1 female) who underwent 4-corner fusion, between 2002 to 2005, with an average of 24 months of follow-up (range, 12–48 months) were made. The mean age of the patients were 32 years (range, 25–48 years). All patients were heavy-labour workers. The aethiology in 77% of the patients was SNAC wrist. Dominant limb was involved in 65% of the patients. All patients were immobilised in a cast for 4 weeks after surgery. Patients were assessed clinically and radiographically. Functional analysis of grip and pinch strenght were performed. RESULTS: Consolidation was obtained in all cases at 10 weeks. Pain evaluation score was 77 at pre-op and 19 on post-op time. The range of flexion – extension movement postoperative was 57°. Average lost of pinch strength was 25%. All patients return to work, 80% to the same activity level and 20% to a different work performing less strenuous activities. After surgery, the range time to return to work was 160 days. CONCLUSION: The four-corner fusion allows an effective stabilization, maintaining the bone stock and eliminate wrist pain. This technique permit a fast return to work with a great level of satisfaction and preserve a functional range of motion with a minimum lost of force in heavy labour workers

Although articular chondrocalcinosis is a frequently seen disorder, the broad clinical variations of forms affecting the wrist are more recently and more rarely described. Chondrocalcinosis of the wrist is an evolutionary disorder, which can initially be well treated medically. Further in the natural evolution, scaphoradial joint destruction occurs followed by midcarpal wear. Until now one form of chondrocalcinosis, developing scapholunate dissociation and tending towards a SLAC (Scapho-Lunate Advanced Collapse) wrist, has been well documented. We state that there exists a pathway which does not lead to any scapholunate gap and is less often associated with a ST (Scapho-Trapezium) osteoarthritis. This isolated form of chondrocalcinosis of the wrist has been mistaken for SLAC or SNAC (Scaphoid Non-union Advanced Collapse) wrists, because its clinical and radiological resemblance. We propose to call this form the SCAC (Scaphoid Chondrocalcinosis Advanced Collapse) wrist. It is seen in elderly patients. There is a long evolution for several years, and most patients have an extensive medical history before the correct diagnosis is being made. We describe the typical clinical and radiological evolution on five patients. According to the amount and pattern of cartilage destruction we propose a radiological classification in four grades. The five cases presented were all seen in grade III. Two of them underwent previous surgery; a styloidectomy in one and a scaphoid replacement by a titanium prosthesis in the other. Three patients had previous carpal tunnel release. All five have been treated by a hamatoluno-capitate arthrodesis, with resection of the scaphoid and triquetrum (according to Delattre’s technique). Results are described and discussed

Aims: Chronic wrist pain has always been a diagnostic challenge. With the introduction of wrist arthroscopy and MRI, previously used techniques such as arthrography and cineradiography were made redundant. However the gold standard of wrist arthroscopy can still fail to diagnose the problem in some patients with chronic wrist pain. The aim of this study was to demonstrate that the combination of arthroscopy with arthrography gives more information, therefore permitting a clearer diagnosis in these patients. Methods: A retrospective cohort study of 40 consecutive patients who underwent wrist arthroscopy for chronic wrist pain, between November 2003 and October 2005. All patients had their investigation and management by a single upper limb consultant orthopaedic surgeon. All had plain x-rays, 42.5% had MRI prior to surgery, and all but one had an intra-operative arthrogram, performed under the same anaesthetic as for the wrist arthroscopy. All demographic data was collected along with history of the patient’s wrist pain, examination, investigations and management. Results: The results showed a ratio of patients 21M: 19F with mean age of 38 years in males and 40 years in females. On examination 15% demonstrated pain with carpal instability. 55% showed pathological findings on their X-rays. 82% of those who had an MRI, had a pathological finding. 97.5% had wrist arthrograms intra-operatively. 56% of these showed pathological findings on wrist arthrogram. In 18%, it altered the differential diagnosis prior to performing the arthroscopy and 38% it reinforced our diagnosis. The final diagnoses after wrist arthrogram and arthroscopy were 42.5% with TFCC injuries, 20% with SNAC pathology, 20% with synovitis with no other pathology, 10% with carpal ligamentous pathology and 7.5% with radiocarpal osteoarthritis. Conclusions: Performing an arthrogram initially provided more information, thereby allowing the surgeon to undertake the arthroscopy with increased accuracy. It also permitted the diagnosis of more subtle findings. Therefore, the arthrogram is another tool in the diagnosis of wrist pathology, and should not be forgotten. It is especially useful in patients with chronic wrist pain, where the diagnosis may be more complicated

Purpose: Transscaphoretrolunate dislocation is the most frequent perilunate dislocation of the carpus (65% according to Herzberg). Treatment remains controversial. The aim of this work was to analyse functional outcome in a homogeneous series of 15 patients treated by open reduction and fixation. Material and methods: This retrospective analysis of 15 patients, mean age 34 years was conducted at four years follow-up. Clinical outcome was based on the Cooney clinical scoring chart. Static and dynamic x-rays of the wrist were studied. The dislocations were: type I=9, type IIa=5, type II=1 according to the Alnot classification. The scaphoid fractures were: types III and IV=13, type II=2. A dorsal approach was used for six cases, an anterolateral approach for four and a double approach for five. The carpal tunnel was opened in seven cases. The scaphid fracture was fixed by pins in eleven cases, by screws in four, and associated with a corticocancellous graft in five. The carpus was fixed in seven cases with scapholunate pins, with lunotriquetral pins in seven, and radiolunate pins in three. Results: Mean score was 70±20% with mean flexion 50±17° and mean extension 54±20°. Grip force was 32/45±11 (Jamar). The thumb-index force was 14±5.1. Pain was negligible in 33% of the patients and was disabling in 17%. Climatic pain was reported by 50% of patients; 75% were able to resume their occupational activities. Radiographically we found osetonecrosis of the lunate (n=1), osteonecrosis of the proximal pole of the scaphoid (n=2), non-union of the scaphoid (n=3), radiocarpal osteoarthritis (n=4), SLAC (n=1) and SNAC (n=2). Discussion: Our outcomes were slightly less favourable than those reported in the literature concerning joint motion. Conversely, for pain, duration of sick leave, and percentage of occupational reclassing, our results were the same as reported in the literature. The series shows that radiographic outcome was favourable with 13% radiocarpal osteoarthritis (38% for Herzberg in 2002 at 96 months. The stability of the scaphoid osteosynthesis remains the key to success (two nonunions for four single pin fixatons). A new analysis at longer follow-up would be interesting to determine the arthrogenic results