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Scaphoid Nonunion Advanced Collapse

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Other Names

  • SNAC

Background

  • Complication of Scaphoid Fracture when there is non-union of the Scaphoid
  • Subsequently, patients develop advanced collapse and progressive arthritis

Pathophysiology

  • Proximal scaphoid fragment tends to remain attached to lunate, distal fragment rotates into flexion
  • Subsequent abnormal interaction of Radius and scaphoid and pancarpal arthritis

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Exam Wrist
  • Patients report weakness, stiffness, reduced grip and pinch strength
  • On exam they are tender at the radioscaphoid junction especially with extension and radial deviation

Evaluation

Radiographs

CT, MRI

  • May have a role in surgical planning

Classification

  • Stage 1: OA between the distal scaphoid fragment, radial styloid
  • Stage 2: Atage 1 + scaphocapitate arthritis
  • Stage 3: Periscaphoid arthritis

Management

Nonoperative

  • Generally considered a surgical problem
  • Seek surgical consultation
  • Nonoperative management in patients who are elderly, frail or low functioning

Operative

  • Depending on staging and surgeon preference, may include
    • Styloidectomy
    • Corpectomy
    • Four-corner fusion
    • Arthrodesis

Return to Play

  • Highly variable at the discretion of the surgeon

Complications

  • Chronic pain
  • Loss of function

See Also


References

Created by:
John Kiel on 26 September 2019 12:41:34
Authors:
Last edited:
13 October 2022 21:49:06
Categories: