SNAC

Definition

 

Scaphoid non union advanced collapse

 

Diagnosis

 

Xray / CT

- non union of scaphoid

- radio-scaphoid OA

 

SNAC Wrist APSNAC Wrist CT

 

Operative Options

 

1.  Radial Styloidectomy 

- technically straightforward 

- should be considered when arthrosis is localized to this region

- may preserve existing motion in the wrist

 

2.  Excision of fragment / Soft tissue interposition

- no intercarpal collapse is present

- a small proximal pole non-union 

 

3.  Scaphoid excision / Silicone replacement 

- shown to be effective when combined with fusion of the capitate to the lunate

 

4.  Proximal row carpectomy

- may also preserve motion

- grip strength unpredictable

- probably only for low demand elderly

 

Proximal Row CarpectomyProximal Row Carpectomy LateralProximal Row Carpectomy Lateral

 

5.  Scaphoidectomy & 4 corner fusion

 

SNAC AdvancedScaphoidectomy and 4 corner fusion

 

6.  Wrist arthrodesis

- provides a stable pain free wrist