Aktuelles Therapiekonzept zur Behandlung des fortgeschrittenen karpalen Kollapses nach Skaphoidpseudarthrose (SNAC-Wrist)

Longstanding scaphoid nonunion will lead to carpal collapse (SNAC-Wrist [scaphoid nonunion advanced collapse]) and wrist arthrosis. The severity of degenerative arthrosis of the wrist is classified into 3 stages (SNAC-Wrist I-III). A treatment algorithm presents an adequate operative therapy for each stage. Reconstruction of the scaphoid is only possible as early as in stage I. In stage II motion preserving procedures such as midcarpal arthrodesis or resection of the proximal carpal row should be performed. In stage III a midcarpal arthrodesis is the treatment of choice. In our own patients we experienced similar outcome results after midcarpal arthrodesis or proximal row carpectomy (PRC) in the treatment of advanced carpal collaps. Both operations preserve postoperative active motion of approximately 60% of the contralateral side. Static grip strength reached approximately 65% of the contralateral side after midcarpal arthrodesis and approximately 50% after PRC. Pain was reduced by approximately 50% with both procedures compared to preoperative values. Due to these favorable results motion preserving procedures should always be preferred instead of a total wrist fusion in the treatment of a SNAC-Wrist.