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Punho SLAC e SNAC

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

Updated Aug 2026
Uma ilustração desenhada à mão de uma pessoa sem rosto, com um pulso rígido e dolorido, tentando abrir um pote.
As etapas da artrise do punho SLAC e SNAC. Kieran Hirpara 4.0

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

Provavelmente, você sente uma dor profunda e latejante na parte posterior do pulso. Isso é comum na artrose SLAC e SNAC do pulso, que são tipos de artrose por desgaste causada por lesões antigas ou suprimento sanguíneo inadequado. A dor geralmente começa gradualmente. Pode parecer uma dor surda que persiste após o uso da mão.

A dor geralmente piora quando você empurra para baixo com a palma da mão. Tarefas simples, como abrir um pote, girar uma maçaneta ou fazer uma flexão, podem desencadear uma dor aguda. Você também pode notar rigidez ao acordar pela manhã. Essa rigidez geralmente melhora após alguns minutos de movimento do pulso. No entanto, forçar além da dor pode fazer com que ela se agrave novamente mais tarde no dia.

As atividades diárias tornam-se mais difíceis de gerenciar. Você pode achar difícil alcançar as costas para fechar um sutiã ou guardar a camisa dentro da calça. Levantar objetos, mesmo os leves, como uma chaleira ou uma sacola de compras, pode parecer instável ou doloroso. Muitos pacientes relatam que dormir do lado afetado é desconfortável. A pressão sobre o pulso pode interromper seu sono, deixando-o cansado e com dores no dia seguinte.

Em alguns casos, você pode sentir uma sensação de travamento ou atrito ao mover o pulso. Isso é causado pela cartilagem desgastada nos pequenos ossos do pulso esfregando uns contra os outros. Você também pode notar algum inchaço ao redor da articulação. Embora a dor seja o principal problema, essa rigidez e sensação de atrito podem fazer com que seu pulso pareça menos confiável.

É importante ouvir o seu corpo. Se certos movimentos causarem dor aguda, tente evitá-los. Seu cirurgião irá ajudá-lo a entender quais atividades são seguras e quais colocam estresse excessivo no seu pulso. Compreender esses sintomas nos ajuda a planejar o tratamento adequado para você.

O que está realmente acontecendo

O seu pulso é composto por oito ossos pequenos que deslizam uns sobre os outros como um sistema complexo de engrenagens. Nos pulsos SLAC e SNAC, as conexões entre esses ossos se desgastam. Isso geralmente começa com um ligamento rompido ou com um osso que não cicatriza após uma fratura. Pense nos ligamentos como cordas resistentes que mantêm as engrenagens no lugar. Quando essas cordas se esticam ou rompem, os ossos perdem o seu alinhamento.

Esse desalinhamento altera a forma como o seu pulso se move. Os ossos começam a roçar uns contra os outros em vez de deslizarem suavemente. Esse desgaste danifica o revestimento liso nas extremidades dos seus ossos, conhecido como cartilagem. À medida que a cartilagem se torna mais fina, você pode sentir dor, rigidez ou uma sensação de travamento. A função normal de absorção de impacto do pulso é perdida, levando aos sintomas que você experimenta nas tarefas diárias.

O seu cirurgião analisa essas alterações para decidir o melhor caminho a seguir. Em alguns casos, a remoção de uma pequena parte de um osso não altera significativamente o movimento do restante do pulso. No entanto, pode causar uma leve inclinação nos ossos próximos. Com o tempo, esse padrão de movimento alterado pode levar à artrite em áreas específicas, como onde o osso escafoide encontra o antebraço.

Nosso objetivo é restaurar a estabilidade e reduzir a dor, corrigindo essas falhas mecânicas. As opções incluem fundir ossos específicos para criar uma unidade sólida e sem dor, ou recobrir as áreas danificadas com implantes. Esses procedimentos são projetados para replicar o eixo natural do seu pulso da maneira mais precisa possível. Ao estabilizar a articulação, ajudamos você a recuperar o movimento funcional, protegendo o tecido saudável restante de mais desgaste.

O que podemos fazer a respeito

O Dr. Kieran Hirpara, cirurgião de membro superior do Mater Private Hospital Rockhampton, aborda esta condição adequando o tratamento ao estágio de desgaste na sua punho. Nossa clínica atende pacientes encaminhados por médicos de família ou fisioterapeutas. Iniciamos com uma avaliação completa, incluindo história clínica, exame físico e exames de imagem, para confirmar o diagnóstico. Para problemas crônicos ou degenerativos, geralmente começamos com tratamento não cirúrgico. Isso inclui a modificação das atividades diárias, acompanhamento com fisioterapeuta, uso de talas e consideração de injeções. Consideramos a cirurgia apenas se essas etapas não proporcionarem melhora suficiente. Se você tiver um problema estrutural ou agudo, podemos recomendar cirurgia imediatamente.

Você pode começar modificando a forma como usa sua mão. Evite levantar pesos pesados ou pegar objetos repetitivamente se isso causar dor. Um fisioterapeuta pode ensinar exercícios para fortalecer os músculos ao redor do seu punho e melhorar a amplitude de movimento. Geralmente, aconselhamos dar uma chance razoável a essa abordagem para ver se reduz seus sintomas. Se a dor persistir, discutimos opções de manejo médico. Isso pode incluir analgésicos de venda livre ou medicamentos anti-inflamatórios. Também oferecemos injeções na articulação do punho. Injeções de cortisona podem reduzir a inflamação e a dor por alguns meses. Injeções de ácido hialurônico podem ajudar a lubrificar a articulação. Injeções de plasma rico em plaquetas (PRP) usam suas próprias células sanguíneas para promover a cicatrização, embora o efeito varie. Essas opções visam controlar a dor e mantê-lo ativo sem cirurgia.

A cirurgia é considerada quando o tratamento conservador atingiu seu limite e sua qualidade de vida está afetada. O objetivo é aliviar a dor e restaurar a função. Os procedimentos podem envolver a fusão de certos ossos ou a remoção de partes danificadas para melhorar o movimento. Por exemplo, a excisão do escafoide e a fusão de quatro ossos remove o osso escafoide e funde outros quatro ossos. Este método fornece resultados funcionais confiáveis e resistentes que permanecem estáveis ao longo do tempo. Outra opção é a artrodese lunocapitata com excisão do escafoide, que oferece resultados funcionais comparáveis à fusão de quatro ossos, mas evita problemas com o osso triquetral. A artrodese radioscapholunar alcança uma taxa de consolidação de 100% em um acompanhamento médio de 12 meses em pacientes selecionados. A artrodese do punho com quatro ossos por meio de placa retangular dorsal alcança uma excelente taxa de consolidação e complicações mínimas. Discutimos essas opções com você para decidir o que é melhor para a sua condição específica do punho.

O que esperar

O seu prognóstico depende das alterações específicas no seu pulso. Para muitos pacientes com artrite degenerativa avançada, a excisão do escafoide e a fusão de quatro ossos (três carpos e o capitato) proporcionam resultados funcionais confiáveis e resilientes, que se mantêm estáveis ao longo do tempo. Pode esperar um bom alívio da dor e preservação da mobilidade. O acompanhamento a longo prazo mostra que os resultados funcionais permanecem bons, apesar das alterações radiográficas na articulação radiolunar em 73% dos pacientes.

Se tiver instabilidade midcarpiana sem artrite avançada, podem ser consideradas opções como fusões parciais do pulso ou estabilizações por tenodese. No entanto, estes procedimentos são frequentemente descritos em pequenas séries de casos com seguimento limitado. Não existem séries comparativas ou estudos randomizados que orientem as expectativas a longo prazo para estes procedimentos específicos.

Para alguns pacientes, a ressecção da fileira proximal dos carpos oferece melhores resultados e uma taxa de complicações mais baixa em comparação com a fusão de quatro ossos. Os pacientes submetidos a este procedimento relatam melhor função nas atividades da vida diária. Se tiver artrite capitolunar avançada, a artrodese de quatro ossos é tipicamente reservada para este cenário. A conversão para fusão total do pulso é baixa após excisão do escafoide e artrodese de quatro ossos para colapso carpal avançado, com um seguimento mínimo de dez anos.

Se deixado sem tratamento, os sintomas do colapso carpal avançado tendem a persistir e podem agravar-se. Alguns pacientes com dissociação carpal complexa recuperam função satisfatória e retornam ao trabalho aos seis meses, com carpo estável nas radiografias. Outros podem experimentar falha radiográfica precoce a curto prazo se os procedimentos específicos não forem cuidadosamente selecionados.

Em geral, o objetivo é reduzir a dor e manter o movimento útil. Embora algumas alterações radiográficas sejam comuns, a sua função clínica e os resultados relacionados com a dor podem permanecer bons. O nosso objetivo é fornecer uma estratégia que preserve o movimento, com uma alta taxa de consolidação óssea. O seu cirurgião ajudá-lo-á a compreender qual o caminho que oferece o resultado mais estável para a anatomia específica do seu pulso.

Quando procurar um especialista

Procure uma avaliação especializada se tiver dor no pulso persistente que não melhora com o repouso. Procure atendimento se notar fraqueza, instabilidade ou uma sensação de travamento ou cedência. Esses sintomas podem interferir no seu sono ou no trabalho diário. A piora súbita da dor também é motivo para agendar uma consulta. A avaliação precoce ajuda o cirurgião a determinar se você precisa de exames de imagem ou opções de tratamento, como a fusão parcial do pulso. Não ignore o desconforto contínuo.

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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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.