Scaphoid Nonunion Advanced Collapse

Other Names

• SNAC

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Background

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

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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

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Risk Factors

• Unknown

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Differential Diagnosis

• Fractures
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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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

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Evaluation

Radiographs

• Standard Radiographs Wrist
• Diagnosis made with 3 view radiographs
• Classified based on radiographs

CT, MRI

• May have a role in surgical planning

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Classification

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

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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

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Return to Play

• Highly variable at the discretion of the surgeon

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Complications

• Chronic pain
• Loss of function

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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