The Treatment of Wrist Osteoarthritis, SLAC Wrist Grade 3-4

Grade 3 and 4 Scapholunate Advanced Collapse (SLAC) wrist is considered the end stage of this particular pattern of arthritis. As with all arthritis the mainstay of conservative treatment consists of activity modification, splinting, nonsteroidal anti-inflammatory medications, and steroid injections. Indirect methods of treating the problem include nerve denervation and arthroscopic lavage. Direct methods of treating the arthritis include proximal row carpectomy (PRC) and scaphoid excision combined with four bone fusion (FBF) which are both motion preserving, pain relieving options, with the caveat that for PRC the capitate head needs to be fairly free of degeneration. However, Grade 3 SLAC wrist by definition includes capitate degeneration. Total wrist replacement is not popular in this post-traumatic setting due to questions of durability. The final option and salvage operation when all other treatments fail is wrist fusion.