This retrospective study compared proximal row carpectomy (PRC) versus limited wrist fusion with scaphoid excision (LWF) in 24 wrists with symptomatic SLAC arthritis. The central question: are outcomes equivalent, and should SLAC stage guide the choice? Patients were followed an average of 5.5 years after surgery.
The pivotal decision in SLAC wrist surgery is not PRC versus LWF — it is whether the capitolunate joint is involved. For Stage I or II SLAC (periscaphoid arthritis, intact capitolunate joint), PRC is the better option: technically simpler, 4 weeks of casting instead of 10, no nonunion risk, and equivalent pain relief and grip strength to LWF.
For Stage III SLAC, PRC is likely to fail on its most important outcome. Pain relief. LWF is your motion-preserving procedure of choice when capitolunate arthritis is present.
When you perform LWF, always confirm on intraoperative imaging that the lunate is fully reduced out of extension before locking in the fusion mass. Six of nine LWF wrists in this series were left with an extended lunate, and every degree of extension lost was preventable.
This retrospective study compared proximal row carpectomy (PRC) versus limited wrist fusion with scaphoid excision (LWF) in 24 wrists with symptomatic SLAC arthritis. The central question: are outcomes equivalent, and should SLAC stage guide the choice? Patients were followed an average of 5.5 years after surgery.
The pivotal decision in SLAC wrist surgery is not PRC versus LWF — it is whether the capitolunate joint is involved. For Stage I or II SLAC (periscaphoid arthritis, intact capitolunate joint), PRC is the better option: technically simpler, 4 weeks of casting instead of 10, no nonunion risk, and equivalent pain relief and grip strength to LWF.
For Stage III SLAC, PRC is likely to fail on its most important outcome. Pain relief. LWF is your motion-preserving procedure of choice when capitolunate arthritis is present.
When you perform LWF, always confirm on intraoperative imaging that the lunate is fully reduced out of extension before locking in the fusion mass. Six of nine LWF wrists in this series were left with an extended lunate, and every degree of extension lost was preventable.