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SLAC at SNAC Wrist

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SLAC/SNAC wrist – understanding pain from arthritis at the wrist, often after injury.

Updated Aug 2026
Isang guhit-kamay na ilustrasyon ng isang walang mukhang tao na may matigas at masakit na pulso, na nahihirapang buksan ang isang bote.
Mga yugto ng SLAC at SNAC arthritis ng pulso. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang malalim at nakakalungkot na sakit sa likod ng iyong pulso. Ito ay karaniwan sa SLAC at SNAC wrist, na mga uri ng arthritis na dulot ng pagkasira dahil sa lumang sugat o mahinang daloy ng dugo. Karaniwang dahan-dahan itong nagsisimula. Maaaring parang mahinang pananakit na nananatili pagkatapos mong gamitin ang iyong kamay.

Karaniwang lumalala ang sakit kapag nagpapababa ka ng iyong palad. Ang mga simpleng gawain tulad ng pagbukas ng bote, pag-ikot ng hawakan ng pinto, o paggawa ng push-up ay maaaring magdulot ng matulis na pananakit. Maaari mo ring mapansin ang pagkahigpit kapag gising ka pa lamang sa umaga. Karaniwang naglalaon ang pagkahigpit na ito pagkatapos mong igalaw ang iyong pulso sa loob ng ilang minuto. Gayunpaman, ang sobrang pagsisikap na lumampas sa sakit ay maaaring magdulot ng paglala nito nang mas huli pa sa araw.

Nagiging mas mahirap ang mga pang-araw-araw na gawain. Maaaring mahirapan kang umabot sa likod mo upang isara ang bra o itabi ang damit. Ang pag-angat ng mga bagay, kahit mga magaan tulad ng kettle o bag ng mga bilihin, ay maaaring maramdaman na hindi matatag o nakakalungkot. Maraming pasyente ang nagsasabi na hindi komportable ang pagtulog sa apektadong gilid. Ang presyon sa pulso ay maaaring makagambala sa iyong pagtulog, na nag-iiwan sa iyo na pagod at nakakalungkot sa susunod na araw.

Sa ilang kaso, maaaring mararamdaman mo ang pakiramdam ng pagkakadikit o pagkagiling kapag gumagalaw ang iyong pulso. Ito ay dulot ng pagkasira ng cartilage sa mga maliit na buto ng iyong pulso na nagkikiskisan. Maaari mo ring mapansin ang ilang pamamaga sa paligid ng kasukasuan. Habang ang sakit ang pangunahing isyu, ang pagkahigpit at pagkagiling na ito ay maaaring gawing hindi maaasahan ang iyong pulso.

Mahalagang makinig sa iyong katawan. Kung ang ilang mga galaw ang nagdudulot ng matulis na sakit, subukang iwasan ang mga ito. Tutulungan ka ng iyong doktor na maunawaan kung aling mga gawain ang ligtas at aling mga gawain ang nagbibigay ng sobrang stress sa iyong pulso. Ang pag-unawa sa mga sintomas na ito ay tumutulong sa amin na magplano ng angkop na gamutan para sa iyo.

Ano ang nangyayari talaga

Ang iyong pulso ay binubuo ng walong maliit na buto na gumagalaw nang magkasama, katulad ng isang kumplikadong sistema ng mga gear. Sa mga pulso na may SLAC at SNAC, ang mga koneksyon sa pagitan ng mga butong ito ay nababagsak. Karaniwang nagsisimula ito sa isang naputol na ligamento o sa isang buto na hindi gumaling matapos ang fracture. Isipin ang mga ligamento bilang matibay na lubid na nagpapatibay sa mga gear. Kapag ang mga lubid na ito ay naging maluwag o naputol, nawawalan ng tamang pagkakahanay ang mga buto.

Ang maling pagkakahanay ay nagbabago sa paraan ng paggalaw ng iyong pulso. Sa halip na maglisan nang maayos, nagsisimula ang mga buto na magkuskusan sa isa’t isa. Ang pagkasira dahil sa paggamit ay nakakasira sa makinis na patong sa dulo ng iyong mga buto, na kilala bilang cartilage. Habang nagnipis ang cartilage, maaari kang maranasan ang sakit, katigasan, o pakiramdam ng pagkakadikit. Nawawala ang normal na kakayahan ng pulso na sumipsip ng shock, na nagdudulot ng mga sintomas na iyong nararanasan sa mga pang-araw-araw na gawain.

Tinitingnan ng iyong doktor ang mga pagbabagong ito upang magdesisyon sa pinakamainam na hakbang. Sa ilang kaso, ang pag-alis ng isang maliit na bahagi ng isang buto ay hindi malaki ang epekto sa paggalaw ng natitirang bahagi ng pulso. Gayunpaman, maaari nitong magdulot ng bahagyang pagkiling sa mga kalapit na buto. Sa paglipas ng panahon, maaaring magdulot ang binagong pattern ng paggalaw ng arthritis sa mga partikular na lugar, tulad ng kung saan ang scaphoid bone ay nagtatagpo sa forearm.

Layunin naming ibalik ang katatagan at bawasan ang sakit sa pamamagitan ng pag-aayos ng mga mekanikal na sira. Kasama sa mga opsyon ang pagpapa-fuse ng mga partikular na buto upang lumikha ng isang matibay at walang sakit na yunit, o ang pag-resurface ng mga nasirang lugar gamit ang mga implant. Ang mga operasyong ito ay idinisenyo upang kopyahin ang natural na axis ng iyong pulso hangga’t maaari. Sa pamamagitan ng pagpapatibay ng joint, tinutulungan naming mabawi mo ang functional na galaw habang pinoprotektahan ang natitirang malusog na tisyu mula sa karagdagang pagkasira.

Ano ang maaari naming gawin para dito

Si Dr. Kieran Hirpara, isang surgeon sa upper-limb sa Mater Private Hospital Rockhampton, ay pinapangasiwaan ang kondisyong ito sa pamamagitan ng pagtutugma ng iyong paggamot sa yugto ng pagkasira ng iyong pulso. Ang aming klinika ay tumatanggap ng mga pasyenteng inirefer ng mga GP o physiotherapist. Sinisimulan namin ang isang kumpletong pagsusuri, kasama ang kasaysayan, pagsusuri, at pag-imaging, upang kumpirmahin ang diagnosis. Para sa mga matagal nang o degenerative na isyu, karaniwang nagsisimula kami sa non-operative na paggamot. Kasama nito ang pagbabago sa mga araw-araw na gawain, pakikipagtulungan sa isang physiotherapist, paggamit ng splint, at pag-aalala sa mga injeksyon. Pinag-iisipan namin ang operasyon lamang kung hindi nagbibigay ng sapat na pagpapabuti ang mga hakbang na ito. Kung mayroon kang isang structural o acute na problema, maaari naming irekomenda ang operasyon agad-agad.

Maaari kang magsimula sa pamamagitan ng pagbabago ng iyong paggamit ng kamay. Iwasan ang mabibigat na pag-angat o paulit-ulit na pagkapit na nagdudulot ng sakit. Matututunan ka ng isang physiotherapist ng mga ehersisyo upang palakasin ang mga kalamnan sa paligid ng iyong pulso at mapabuti ang range of motion. Karaniwang inirerekomenda namin na bigyan ng patas na pagsubok ang paraang ito upang makita kung ito ay makakabawas ng iyong mga sintomas. Kung mananatiling may sakit, pinag-uusapan namin ang mga opsyon sa medical na pamamahala. Maaari itong kasama ang over-the-counter na pagpapagaan ng sakit o mga gamot laban sa pamamaga. Nag-aalok din kami ng mga injeksyon sa loob ng joint ng pulso. Maaaring bawasan ng mga injeksyon ng cortisone ang pamamaga at sakit sa loob ng ilang buwan. Maaaring tumulong ang mga injeksyon ng hyaluronic acid upang lubrikahan ang joint. Ang mga injeksyon ng platelet-rich plasma (PRP) ay gumagamit ng iyong sariling mga selula ng dugo upang itaguyod ang paggaling, bagaman nag-iiba ang epekto. Layunin ng mga opsyong ito na pamahalaan ang sakit at panatilihing aktibo ka nang walang operasyon.

Isinasaalang-alang ang operasyon kapag naabot na ng conservative na paggamot ang hangganan nito at apektado ang iyong kalidad ng buhay. Ang layunin ay bawasan ang sakit at ibalik ang function. Maaaring kabilang sa mga prosedura ang pagpapa-fuse ng ilang buto o pag-alis ng mga nasirang bahagi upang mapabuti ang galaw. Halimbawa, ang scaphoid excision at four-corner fusion ay nag-aalis ng scaphoid bone at nagf-fuse ng apat na ibang buto. Nagbibigay ang paraang ito ng maaasahan at matibay na functional na resulta na nananatiling stable sa paglipas ng panahon. Ang isa pang opsyon ay ang lunocapitate arthrodesis na may scaphoid excision, na nag-aalok ng functional na resulta na katumbas ng four-corner fusion ngunit iiniiwasan ang mga isyu sa triquetrum bone. Ang radioscapholunate arthrodesis ay nakakamit ng 100% union rate sa isang mean follow-up na 12 buwan sa mga napiling pasyente. Ang four-corner bone wrist arthrodesis sa pamamagitan ng dorsal rectangular plating ay nakakamit ng mahusay na rate ng consolidation at minimal na komplikasyon. Pinag-uusapan namin ang mga opsyong ito sa iyo upang desisyunin kung alin ang pinakamainam para sa iyong partikular na kondisyon ng pulso.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa tiyak na mga pagbabago sa iyong pulso. Para sa maraming pasyente na may advanced na wear-and-tear arthritis, ang scaphoid excision at four-corner fusion ay nagbibigay ng maaasahan at matibay na mga resulta sa pag-andas na nananatiling matatag sa paglipas ng panahon. Inaasahan mo ang mahusay na pagpapagaan ng sakit at pinapanatiling galaw. Ang long-term follow-up ay nagpapakita na ang mga resulta sa pag-andas ay nananatiling mahusay kahit may mga pagbabago sa radiolunate joint sa 73% ng mga pasyente.

Kung mayroon kang midcarpal instability nang walang advanced na arthritis, maaaring isaalang-alang ang mga pagpipilian tulad ng partial wrist fusions o tenodesis stabilizations. Gayunpaman, madalas itong inilalarawan sa maliit na case series na may limitadong follow-up. Walang mga comparative series o randomized studies upang gabayan ang long-term na mga inaasahan para sa mga partikular na prosedurong ito.

Para sa ilang mga pasyente, ang proximal row carpectomy ay nag-aalok ng mas magagandang resulta at mas mababang rate ng komplikasyon kumpara sa four-corner fusion. Ang mga pasyente pagkatapos ng prosedurong ito ay nag-ulat ng mas magandang pag-andas sa mga gawain pang-araw-araw. Kung mayroon kang advanced na capitolunate arthritis, ang four-corner arthrodesis ay karaniwang inilaan para sa senaryong ito. Mababa ang conversion sa total wrist fusion pagkatapos ng scaphoid excision at four-corner arthrodesis para sa advanced na carpal collapse sa isang minimum na sampung taon.

Kung iiwan itong walang ginawa, ang mga sintomas ng advanced na carpal collapse ay may tendensyang manatili at maaaring lumala. Ang ilang mga pasyente na may complex na carpal dissociation ay nakakabalik ng sapat na pag-andas at bumabalik sa trabaho sa anim na buwan na may matatag na carpus sa radiographs. Ang iba ay maaaring maranasan ang maagang radiographic failure sa maikling panahon kung ang mga partikular na prosedurong hindi maingat na napili.

Sa kabuuan, ang layunin ay bawasan ang sakit at mapanatili ang kapaki-pakinabang na paggalaw. Habang ang ilang mga pagbabago sa radiograph ay karaniwan, ang iyong klinikal na pag-andas at mga resulta sa sakit ay maaaring manatiling mahusay. Layunin naming magbigay ng isang estratehiyang nagpapanatili ng galaw na may mataas na union rate. Ang iyong surgeon ay tutulong sa iyo na maunawaan kung alang landas ang nag-aalok ng pinakamatatag na resulta para sa iyong tiyak na anatomiyang pulso.

Kailan kumonsulta sa doktor

Maghingi ng pagsusuri ng espesyalista kung mayroon kang patuloy na sakit sa pulso na hindi gumagaling kahit may pahinga. Humingi ng medikal na tulong kung napapansin mo ang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak. Maaaring makagambala ang mga sintomas na ito sa iyong pagtulog o pang-araw-araw na trabaho. Ang biglaang paglala ng sakit ay dahilan din upang mag-book ng appointment. Ang maagang pagsusuri ay tumutulong sa iyong surgeon na matukoy kung kailangan mo ng pag-imaging o mga pagpipilian sa paggamot tulad ng parsyal na wrist fusion. Huwag balewalain ang patuloy na discomfort.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Both proximal row carpectomy and four-corner fusion provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists [1].
  • Midcarpal arthrodesis is a reliable procedure for treating SLAC- and SNAC-wrists in stages II and III [2].
  • Midcarpal arthrodesis preserves some range of motion in the treatment of SLAC- and SNAC-wrists [2].
  • Scaphoid excision and four-corner fusion is indicated for the treatment of the SLAC/SNAC wrist when significant pain is refractory to nonoperative measures [3].
  • Limited carpal fusion is favored over proximal row carpectomy for patients treated for SNAC and SLAC wrist conditions, except for flexion-extension and grip strength in women [4].
  • Bone density is greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls [6].
  • Successful scaphoid reconstruction in SNAC wrists shifts the load back onto the proximal pole [10].
  • Successful scaphoid reconstruction in SNAC wrists interrupts the otherwise inevitable degenerative pattern in scaphoid nonunions [10].
  • Arthroscopic wrist debridement and radial styloidectomy is indicated for SLAC II or SLAC III wrists as an intermediate step to relieve pain and preserve functional motion [12].
  • Scaphoidectomy and capsulodesis is mostly indicated as a palliative procedure in elderly patients with posttraumatic SNAC or SLAC wrist with limited functional demands [17].
  • Arthroscopic wrist debridement and radial styloidectomy may have advantages in relieving pain while preserving wrist motion for SLAC stage 2 or 3 disease [20].
  • Proximal row carpectomy is preferred for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease [25].
  • Arthroscopic resection arthroplasty of the radial column (ARARC) may be a viable surgical option for patients with SLAC wrist who desire a minimally invasive procedure [28].

Anatomy & Pathophysiology

  • SNAC wrists exhibit a distinct pathomechanism of carpal instability characterized by a decreased sagittal lunotriquetral angle compared to SLAC wrists [5].
  • Carpal malalignment in SLAC wrists affects the radio- and midcarpal joints and extends to the third carpometacarpal joint, with malalignment evident in both the sagittal and coronal planes [14].
  • Radiographic classification of SLAC wrist has moderate reliability and reproducibility [7].
  • Radiographic classification of SNAC wrist has limited reliability [7].
  • Staging systems for SNAC wrist lack agreement [11].
  • The Watson and Ballet classification of SLAC wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment despite significant limitations [18].
  • Patients with SLAC wrist are more likely to be male and have a history of trauma compared to patients with first CMC OA [9].
  • There is currently no scientific evidence that a scapholunate ligament injury visualized arthroscopically, without static x-ray changes, inevitably leads to SLAC wrist [13].

Classification

  • The diagnosis of SLAC wrist should be reserved for patients in whom a traumatic disruption of the proximal carpal row has initiated the defined sequence of arthritic change outlined by Watson and Ballet [8].
  • Patients with SLAC wrist are more likely to be male and have a history of trauma compared to patients with first carpometacarpal (CMC) osteoarthritis [9].
  • Classification of SNAC wrist has limited reliability [7].
  • SNAC wrists differ from SLAC wrists by exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [5].
  • Distal row pronation and translation and radiolunate arthritis are demonstrated in SNAC wrists via quantitative 3-D CT [6].
  • Scaphotrapeziotrapezoid (SOAC) joint osteoarthritis is differentiated from SLAC wrist, with the SOAC staging system guiding treatment decisions [15].

Clinical Presentation

  • SLAC and SNAC wrists are characterized by symptomatic arthritis requiring intervention when pain is refractory to nonoperative measures [3].
  • SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability [5].

Investigations

  • SNAC wrists exhibit a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability compared to SLAC wrists [5].
  • The diagnosis of SLAC should be reserved for patients in whom a traumatic disruption of the proximal carpal row has initiated the defined sequence of arthritic change outlined by Watson and Ballet [8].
  • Patients with SLAC wrist were more likely to be male and have a history of trauma compared to patients with first CMC OA [9].
  • SOAC staging system can guide treatment decisions and differentiates SOAC from SLAC wrist [15].

Treatment

  • Proximal row carpectomy provides improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists [1].
  • Four-corner fusion provides improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists [1].
  • Limited carpal fusion is favored over proximal row carpectomy in patients treated for SNAC and SLAC wrist conditions, except for flexion-extension and grip strength in women [4].
  • Trapeziometacarpal joint arthritis and SLAC wrist may be treated either simultaneously or in stages [16].
  • Distal scaphoid resection is a durable procedure with good long-term results for arthritis secondary to scaphoid nonunion [19].
  • 94% of patients remained satisfied after distal scaphoid resection for arthritis secondary to scaphoid nonunion [19].
  • No further wrist collapse or radiocarpal arthritis developed after distal scaphoid resection for arthritis secondary to scaphoid nonunion [19].
  • Successful scaphoid reconstruction in SNAC wrists shifts the load back onto the proximal pole and interrupts the otherwise inevitable degenerative pattern in scaphoid nonunions [10].

Complications

  • Proximal row carpectomy and four-corner fusion both provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists [1].
  • Limited carpal fusion is favored over proximal row carpectomy for SNAC and SLAC wrist conditions, except for flexion-extension and grip strength in women [4].
  • SNAC wrists exhibit a decreased sagittal lunotriquetral angle compared to SLAC wrists, indicating a distinct pathomechanism of carpal instability [5].
  • Distal scaphoid resection arthroplasty produced favorable, long-term clinical results for degenerative arthritis secondary to scaphoid nonunion [29].
  • Distal scaphoid resection arthroplasty did not result in noteworthy wrist collapse for degenerative arthritis secondary to scaphoid nonunion [29].

Recovery

  • Scaphoid excision and four-corner fusion is indicated for the treatment of SLAC/SNAC wrist when significant pain is refractory to nonoperative measures [3].
  • Successful scaphoid reconstruction interrupts the otherwise inevitable degenerative pattern in scaphoid nonunions [10].
  • 94% of patients remained satisfied following distal scaphoid resection for arthritis secondary to scaphoid nonunion [19].
  • No further wrist collapse or radiocarpal arthritis developed following distal scaphoid resection for arthritis secondary to scaphoid nonunion [19].
  • Functional results of four-corner fusion for SLAC and SNAC wrist are good at long-term follow-up [30].
  • Radiographic changes in the radiolunate joint occur in 73% of patients following four-corner fusion for SLAC and SNAC wrist [30].

Key Evidence

  • [L4] Both procedures provide improvements in pain and subjective outcome measures for patients with symptomatic and appropriately staged SLAC or SNAC wrists. [1] (10.1177/1753193408100954)
  • [L4] Our data demonstrate that midcarpal arthrodesis is a reliable procedure for treating SLAC- and SNAC-wrists in stages II and III and, furthermore, one which preserves some range of motion. [2] (10.1097/01.sap.0000194245.94684.54)
  • [L4] Scaphoid excision and four-corner fusion is indicated for the treatment of the SLAC/SNAC wrist when significant pain is refractory to nonoperative measures. [3] (10.1053/otor.2003.36321)
  • [L3] Among patients treated for SNAC and SLAC wrist conditions, findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy, except for flexion-extension and grip strength in women. [4] (10.1186/s13018-023-04177-7)
  • [L4] SNAC wrists differ from SLAC wrists in exhibiting a decreased sagittal lunotriquetral angle, indicating a distinct pathomechanism of carpal instability. [5] (10.1186/s12891-025-08652-6)
  • [L3] Bone density was greater at the capitolunate joint, the radial styloid, and the radiolunate joint in SNAC wrists compared to controls. [6] (10.2106/jbjs.22.01350)
  • [L4] Radiographic classification of SLAC wrist has moderate reliability and reproducibility, whereas classification of SNAC wrist has limited reliability. [7] (10.1177/1753193413484629)
  • [L5] The diagnosis of SLAC should be reserved for patients in whom a traumatic disruption of the proximal carpal row has initiated the defined sequence of arthritic change outlined by Watson and Ballet. [8] (10.1016/j.jhsa.2015.06.110)
  • [L3] Patients with SLAC wrist were more likely to be male and have a history of trauma compared to patients with first CMC OA. [9] (10.1177/1558944718788672)
  • [L4] Successful scaphoid reconstruction in SNAC wrists shifts the load back onto the proximal pole and interrupts the otherwise inevitable degenerative pattern in scaphoid nonunions. [10] (10.1016/j.jhsa.2018.06.104)
  • [Paper] Staging systems for SNAC wrist lack agreement. [11] (10.1007/s12593-012-0062-2)
  • [L4] The procedure is indicated for SLAC II or SLAC III wrists as an intermediate step to relieve pain and preserve functional motion. [12] (10.1016/j.arthro.2012.04.108)
  • [L5] There is currently no scientific evidence that a scapholunate ligament injury visualized arthroscopically, without static x-ray changes, inevitably leads to SLAC wrist. [13] (10.1016/j.jhsa.2011.01.018)
  • [L3] Carpal malalignment in SLAC wrists not only affects the radio- and midcarpal joints, but also extends to the third carpometacarpal joint, with malalignment evident in both the sagittal and coronal planes. [14] (10.1016/j.jhsa.2024.09.021)
  • [L4] It also differentiates SOAC from SLAC wrist and discusses how the SOAC staging system can guide treatment decisions. [15] (10.5435/jaaos-d-25-01408)
  • [L4] Trapeziometacarpal joint arthritis and SLAC wrist may be treated either simultaneously or in stages. [16] (10.1016/j.jhsa.2021.05.002)
  • [L4] It is mostly indicated as a palliative procedure in elderly patients with posttraumatic SNAC or SLAC wrist with limited functional demands. [17] (10.1055/s-0032-1329615)
  • [L5] Despite its significant limitations, the Watson and Ballet classification of SLAC wrist osteoarthritis is widely accepted, simple, and a well-recognized guide to treatment. [18] (10.1097/corr.0000000000000451)
  • [L4] Distal scaphoid resection is a durable procedure with good long-term results. 94% of patients remained satisfied, and no further wrist collapse or radiocarpal arthritis developed. [19] (10.1016/s0363-5023(11)60002-6)
  • [L4] The procedure studied may have advantages in relieving pain while preserving wrist motion for SLAC stage 2 or 3 disease. [20] (10.1177/1558944717725383)
  • [L3] The authors prefer proximal row carpectomy for SLAC wrists with preserved capitate head cartilage due to socio-economic benefits, lower complication rates, and procedural ease. [25] (10.1177/1753193408087116)
  • [L4] ARARC may be a viable surgical option for patients with SLAC wrist who desire a minimally invasive procedure. [28] (10.1055/s-0034-1373839)
  • [L4] Distal scaphoid resection arthroplasty produced favorable, long-term clinical results and did not result in noteworthy wrist collapse. [29] (10.1016/j.jhsa.2014.05.031)
  • [L4] Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. [30] (10.1177/1558944716681949)

References

[1] Proximal Row Carpectomy vs Four Corner Fusion for Scapholunate (Slac) or Scaphoid Nonunion Advanced Collapse (Snac) Wrists: A Systematic Review of Outcomes. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408100954

[2] Long-Term Results of Midcarpal Arthrodesis in the Treatment of Scaphoid Nonunion Advanced Collapse (SNAC-Wrist) and Scapholunate Advanced Collapse (SLAC-Wrist). Annals of Plastic Surgery. 2006. DOI: 10.1097/01.sap.0000194245.94684.54

[3] Scaphoid excision and four-corner fusion in the SLAC/SNAC wrist. Operative Techniques in Orthopaedics. 2003. DOI: 10.1053/otor.2003.36321

[4] Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04177-7

[5] Computer-aided three-dimensional analysis of carpal alignment in scaphoid nonunion advanced collapse wrists: A comparative study with scapholunate advanced collapse and healthy wrists. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08652-6

[6] Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.01350

[7] Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413484629

[8] Scapholunate Advanced Collapse: Nomenclature and Differential Diagnosis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.110

[9] The Epidemiology of Scapholunate Advanced Collapse. HAND. 2018. DOI: 10.1177/1558944718788672

[10] Long-Term Results of Scaphoid Grafting in 52 SNAC Wrists: Should We Cut Down on Salvage Procedures?. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.104

[11] Scaphoid Nonunion Advanced Collapse Classifications: A Reliability Study. Journal of Hand and Microsurgery. 2012. DOI: 10.1007/s12593-012-0062-2

[12] Arthroscopic Wrist Debridement and Radial Styloidectomy for Late‐stage Scapholunate Advanced Collapse Wrist (SS‐49). Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.108

[13] Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Arthritis—Update on Evaluation and Treatment. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.01.018

[14] Comparative Computer-Aided Analysis of Three-Dimensional Carpal Alignment in Scapholunate Advanced Collapse and Healthy Wrists. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.021

[15] Scaphotrapeziotrapezoid Joint Osteoarthritis: Differentiating SOAC Wrist From SLAC Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-01408

[16] Combined Treatment of Trapeziometacarpal Joint Arthritis and Scapholunate Advanced Collapse Wrist. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.05.002

[17] Scaphoidectomy and Capsulodesis for SNAC or SLAC Stage II. Journal of Wrist Surgery. 2012. DOI: 10.1055/s-0032-1329615

[18] Classifications in Brief: Watson and Ballet Classification of Scapholunate Advanced Collapse Wrist Arthritis. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1097/corr.0000000000000451

[19] Distal Scaphoid Resection for Arthritis Secondary to Scaphoid Nonunion: A Twenty-year Experience. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60002-6

[20] Arthroscopic Wrist Debridement and Radial Styloidectomy for Advanced Scapholunate Advanced Collapse Wrist: Long-term Follow-up. HAND. 2017. DOI: 10.1177/1558944717725383

[25] Proximal Row Carpectomy Versus Four-Corner Arthrodesis as a Treatment for SLAC (Scapholunate Advanced Collapse) Wrist. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087116

[28] Arthroscopic Resection Arthroplasty of the Radial Column for SLAC Wrist. Journal of Wrist Surgery. 2014. DOI: 10.1055/s-0034-1373839

[29] Distal Scaphoid Resection for Degenerative Arthritis Secondary to Scaphoid Nonunion: A 20-Year Experience. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.05.031

[30] Ten-Year Minimum Follow-Up of 4-Corner Fusion for SLAC and SNAC Wrist. HAND. 2016. DOI: 10.1177/1558944716681949

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