• Vol. 42 No. 6, 278–284
  • 15 June 2013

An Alternative Treatment Option for Scaphoid Nonunion Advanced Collapse (SNAC) and Radioscaphoid Osteoarthritis: Early Results of a Prospective Study on the Pyrocarbon Adaptive Proximal Scaphoid Implant (APSI)

108



108 Views
17 Downloads

Download PDF

ABSTRACT

Introduction: Scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis are difficult to treat. Options include proximal row carpectomy (PRC), four corner fusion (4CF) and wrist arthroplasty or arthrodesis. However, with inevitable disease progression, a significant proportion of patients undergo total wrist fusion. This reduces function by abolishing wrist movement. We review the preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients from our prospective study and challenge the assumption that there are no surgical alternatives.

Materials and Methods: This study prospectively studied 12 consecutive pyrocarbon interpositional arthroplasty day cases over 3 years. Patients were assessed using level of pain, ranges of motion, grip strength, key pinch, type of and time to return to work and the disabilities of the arm, shoulder and hand (DASH) score, both preoperatively and postoperatively. Radiographs were also taken and patient satisfaction recorded.

Results: All 12 patients could be contacted and were satisfied with their surgery. There were no immediate, early or late postoperative complications associated with the procedure. Promising results were noted in terms of pain, ranges of motion, grip strength, key pinch, type of and time to return to work, DASH scores, photographs and radiographs. The mean follow-up was 18 months, range between 11 months and 3 years.

Conclusion: Our early results are encouraging, warrant further and longer studies and support the use of pyrocarbon implants as a primary procedure in what is a generally young and active subgroup of patients.


Scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis are well recognised conditions that are considered very difficult to treat, not only by general orthopaedic surgeons but also hand and upper limb specialists. Some of the more popular treatment options for SNAC wrists include proximal row carpectomy (PRC) and four corner fusion (4CF). A systematic review in 2009 compared these 2 procedures and found grip strength, pain relief and subjective outcomes to be similar in both treatment groups.

This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.