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Arthroscopic Wrist Debridement and Radial Styloidectomy for Late-stage Scapholunate Advanced Collapse Wrist
Michael V. Birman, MD; Jonathan R. Danoff, MD; Melvin P. Rosenwasser, MD
Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY

Hypothesis:  For patients with symptomatic stage II or III scapholunate advanced collapse (SLAC) wrist, we hypothesize that arthroscopic wrist debridement and radial styloidectomy is a safe and effective procedure to obtain significant pain relief and improved wrist function, and thereby delay or avoid salvage procedures, such as proximal row carpectomy (PRC) or partial/total wrist arthrodesis.  The purpose of this study is to assess the outcomes and clarify the indications for this procedure.

Methods: Over 7 years, the senior author performed this procedure for 8 SLAC wrists in 7 patients.  The procedure consists of wrist arthroscopy, synovectomy, and arthroscopic radial styloidectomy; three of the 8 wrists underwent additional neurectomies of the anterior and posterior interosseous nerves.  Data collected at final follow-up included outcome scores (DASH, SF-36, and visual analog pain scale), mobility measurements, and patientís functional assessment and satisfaction. 

Results: Seven wrists in 6 patients were available for questionnaires; one patient was unavailable for examination.  At arthroscopy, 3 were staged as SLAC II and 4 as SLAC III. The mean time to final follow-up was 28 months (range 4 - 88 months). One patient was revised to a wrist arthrodesis at 79 months after the arthroscopic procedure and had a DASH score of 65 and VAS pain of 96 post-arthrodesis.  

For the other 6 cases, the mean DASH score at follow-up was 21 (range 0 - 35, SD 12) and the mean VAS pain score with activity was 35 (range 0 - 88, SD 37).  Divided into SLAC II and III, the mean DASH scores were 17 and 25, respectively.  Their mean wrist flexion was 56 degrees and extension was 50 degrees.  In this small series, patients were satisfied with the results of 5 of the 7 procedures.

Summary Points:

  • Arthroscopic debridement and radial styloidectomy can be an effective procedure to delay or prevent PRC or intercarpal arthrodesis.
  • The procedure is indicated for SLAC II or SLAC III wrists as an intermediate step to relieve pain and preserve functional motion.
  • Arthroscopic removal of radial styloid-scaphoid impingement in conjunction with wrist denervation may be reasonable first alternative to more complex wrist salvage procedures in patients with advanced SLAC.

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