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SLAC腕和SNAC腕

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

Updated Aug 2026
一幅手绘插图，描绘了一个没有面孔的人，手腕僵硬且疼痛，正努力打开一个罐子。
SLAC和SNAC腕关节炎的分期。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感到手腕背部出现深部的酸痛。这在 SLAC（舟月骨前向半脱位性腕关节骨关节炎）和 SNAC（舟骨前向半脱位性腕关节骨关节炎）中很常见，这两者都是由旧伤或血液供应不良引起的磨损性关节炎。疼痛通常逐渐开始。它可能表现为一种钝痛，在您使用手部后会持续存在。

当您用手掌向下推时，疼痛通常会加剧。简单的任务，如打开罐子、转动门把手或做俯卧撑，可能会引发尖锐的酸痛。您可能还会注意到早晨刚醒来时手腕僵硬。这种僵硬通常在活动手腕几分钟后缓解。然而，如果强行忍受疼痛，可能会导致疼痛在当天晚些时候再次发作。

日常活动变得难以应对。您可能会发现很难将手伸到背后扣上胸罩或塞好衬衫。提起物体，即使是像水壶或一袋杂货这样轻的物品，也可能感觉不稳定或疼痛。许多患者报告说，侧卧在受影响的一侧睡觉会感到不适。手腕上的压力会干扰您的睡眠，导致您第二天感到疲惫和酸痛。

在某些情况下，当您活动手腕时，可能会感觉到卡住或研磨的感觉。这是由手腕小骨头中磨损的软骨相互摩擦引起的。您可能还会注意到关节周围有些肿胀。虽然疼痛是主要问题，但这种僵硬和研磨感会使您的手腕感觉不那么可靠。

倾听您身体的声音很重要。如果某些动作引起尖锐的疼痛，请尽量避免它们。您的外科医生将帮助您了解哪些活动是安全的，哪些活动会给您的手腕带来过多的压力。了解这些症状有助于我们为您制定适当的治疗方案。

实际发生了什么

您的手腕由八块小骨头组成，它们像复杂的齿轮系统一样相互滑动。在SLAC（舟月骨进行性塌陷）和SNAC（舟骨不愈合性进行性塌陷）腕关节中，这些骨头之间的连接会发生退化。这通常始于韧带撕裂或骨折后骨头未能愈合。可以将韧带想象成将齿轮固定在一起的坚固绳索。当这些绳索拉伸或断裂时，骨头就会失去其正常排列。

这种排列异常会改变您手腕的运动方式。骨头开始相互研磨，而不是平滑滑动。这种磨损会损伤骨头末端的光滑覆盖层，即软骨。随着软骨变薄，您可能会感到疼痛、僵硬或卡顿感。手腕正常的减震功能丧失，导致您在日常活动中出现症状。

您的外科医生会根据这些变化决定最佳的治疗方案。在某些情况下，切除一小部分骨头并不会显著影响手腕其余部分的运动。然而，这可能会导致邻近骨头出现轻度倾斜。随着时间的推移，这种改变的运动模式可能导致特定区域发生关节炎，例如舟骨与前臂相接处。

我们的目标是通过解决这些机械故障来恢复稳定性并减轻疼痛。治疗选项包括将特定骨头融合在一起，形成一个坚固且无痛的整体，或使用植入物对受损区域进行表面置换。这些手术旨在尽可能模拟您手腕的自然运动轴。通过稳定关节，我们帮助您恢复功能性活动，同时保护剩余的healthy组织免受进一步磨损。

我们能做什么

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 博士根据您手腕磨损的阶段来匹配治疗方案。我们的诊所接收由全科医生或物理治疗师转诊的患者。我们首先进行全面评估，包括病史、体格检查和影像学检查，以确诊。对于长期或退行性问题，我们通常从非手术治疗开始。这包括改变日常活动、与物理治疗师合作、使用夹板以及考虑注射治疗。只有当这些措施未能提供足够的改善时，我们才会考虑手术。如果您存在结构性或急性问题，我们可能会立即建议手术。

您可以从改变手部使用方式开始。避免提重物或引起疼痛的重复性抓握动作。物理治疗师可以教您锻炼手腕周围肌肉并改善活动范围的练习。我们通常建议充分尝试这种方法，看是否能减轻您的症状。如果疼痛持续存在，我们会讨论药物治疗方案。这可能包括非处方止痛药或抗炎药。我们还提供手腕关节注射。皮质类固醇注射可以在几个月内减轻炎症和疼痛。透明质酸注射可能有助于润滑关节。富血小板血浆（PRP）注射利用您自身的血细胞促进愈合，尽管效果因人而异。这些选项旨在通过非手术方式管理疼痛并保持您的活动能力。

当保守治疗达到极限且您的生活质量受到影响时，才会考虑手术。目标是缓解疼痛并恢复功能。手术可能涉及将某些骨骼融合在一起或切除受损部分以改善活动。例如，舟骨切除及四角融合术切除舟骨并融合其他四块骨骼。该方法提供可靠、耐用的功能结果，且随时间推移保持稳定。另一种选择是舟骨切除及月头骨融合术，其功能结果与四角融合术相当，但避免了三角骨相关的问题。在选定患者中，桡舟月骨融合术在平均随访 12 个月时达到 100% 的骨愈合率。通过背侧矩形接骨板进行四角骨腕关节融合术可实现优异的骨愈合率和极少的并发症。我们会与您讨论这些选项，以确定最适合您特定手腕状况的方案。

预期情况

您的预后取决于腕部的具体改变。对于许多患有严重磨损性关节炎的患者，舟骨切除联合四角融合术可提供可靠、持久的功能结果，且长期保持稳定。您可以期待良好的疼痛缓解和保留的活动度。长期随访显示，尽管73%的患者在影像学上出现桡月关节的改变，但其功能结果仍然良好。

如果您存在中腕关节不稳而无严重关节炎，可考虑部分腕关节融合术或肌腱固定术等稳定措施。然而，这些方法通常在随访有限的小型病例系列中描述。目前缺乏比较性系列研究或随机对照研究来指导这些特定手术的长期预后。

对于部分患者，与四角融合术相比，近排腕骨切除术可提供更好的结果和更低的并发症发生率。接受该手术的患者报告称，其在日常生活活动中的功能更佳。如果您存在严重的头钩关节关节炎，四角融合术通常仅适用于此情况。在至少十年的随访中，针对严重腕骨塌陷行舟骨切除联合四角融合术后，转换为全腕关节融合术的比例较低。

若不予治疗，严重腕骨塌陷的症状往往持续存在并可能加重。部分复杂腕骨分离的患者在影像学显示腕骨稳定的情况下，可在六个月内恢复满意的功能并重返工作岗位。如果未仔细选择特定手术，其他患者可能在短期内出现早期的影像学失败。

总体而言，目标是减轻疼痛并维持有用的活动度。虽然某些影像学改变很常见，但您的临床功能和疼痛结果仍可保持良好。我们的目标是提供一种保留活动度且骨愈合率高的策略。您的外科医生将帮助您了解哪种方案能为您的特定腕部解剖结构提供最稳定的结果。

何时就诊

如果您有持续不缓解的腕部疼痛，即使休息后仍无改善，请寻求专科医生评估。如果您注意到出现无力、不稳定感，或有关节卡住或突然无力（打软腿）的感觉，请立即就医。这些症状可能会干扰您的睡眠或日常工作。疼痛突然加重也是预约就诊的理由。早期评估有助于您的外科医生判断您是否需要影像学检查或治疗选择，如部分腕关节融合术。请勿忽视持续的疼痛不适。

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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