REVIEW – May 2018

Posttraumatic wrist arthritis

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Posttraumatic arthritis is the most common form of osteoarthritis in the wrist. The main traumas that lead to arthritic changes are scaphoid fracture malunions or nonunions, ligament injuries and carpal bone dislocations.

Patients with posttraumatic arthrosis usually seek medical help because of pain in everyday activities.

Traumatic changes in the wrist lead to shifts in joint kinematics, thus resulting in cartilage wear. Scapholunate advanced collapse (SLAC) refers to a pattern of progressive wrist malalignment and arthritis that is attributed to scapholunate ligament injury. Scaphoid nonunion advanced collapse (SNAC) is a term used to describe similar changes in the wrist after scaphoid fracture nonunion.

First line treatment is conservative symptomatic treatment with wrist splints, NSAIDs and intraarticular corticosteroid injections. If this fails to reduce symptoms, surgery has to be considered. Proximal row carpectomy, 4-corner arthrodesis and total wrist arthrodesis are the most common operations used to relieve the symptoms of SLAC and SNAC wrists.

None of the surgical methods is superior to others. In the decision making process when choosing the surgical method, patient’s age, physical activity and expectations, as well as radiological findings, have to be taken into account.