Summary

Impressive results of closing wedge radial osteotomy for SNAC wrist allowing returin to sport

Abstract

Introduction

Wrist osteoarthritis can lead to mechanical pain, limitation of ROM and decreased strength, being a significant burden on the patient’s life. Proximal row carpectomy and 4-corner-fusion are the mainstay of treatment for SLAC/SNAC III-IV wrists, with limited symptom-free duration and limited ROM respectively restricting their efficacy.

Aim

Our study aims to showcase the results of closed wedge radial osteotomy on SLAC/SNAC osteoarthritic wrists and scaphoid non-union. The technique has been mainly described for Kienbock’s disease in the literature with promising results and due to its offloading effect on the scaphoid we hypothesized it will improve the functional status in our patient group.
Material-Methods: 14 patients with varied wrist pathology among SNAC, SLAC and scaphoid non-union were treated with closed radial wedge osteotomy at the metaphysis. A detailed clinical examination was performed pre- and postoperatively containing PRWE, MMWS, VAS score and ROM. The mean radial angulation was also measured on the pre- and postoperative xrays.

Results

The mean age of our patients was 56.7+-9.1. 6 patients were facing SNAC, 2 patients SLAC and 6 patients scaphoid non-union. All patients were treated with radial closed wedge osteotomy at the metaphysis and showed excellent healing at the fracture site. The mean PRWE and MMWS were improved from 85.3+-4.8 to 19.7+-24.5 and from 15.8+-5.2 to 78.2+-22.4 respectively. Statistically significant difference was also noted on the VAS score (from 9.2+-0.7 to 2.7+-2.2) and ROM. The mean radial angulation was reduced from 118.1o +-1.5o to 107.3o+-1.9o.

Conclusion

The closing radial wedge osteotomy presented promising results in our case series regarding ROM and pain. The technique could prove a reliable first line treatment for patients with debilitating wrist osteoarthritis confined to scaphoid/scapholunate articulation with radius as it preserves the ligamentous insertions and the bone stock, maintaining the option for more extensive wrist treatments in the future.The athletes participating in the study were participating in sports (push-ups or ping-pong etc.) pain free post-operatively, allowing for return to sport.


Keywords: SLAC, SNAC, scaphoid, wrist, radial osteotomy