Presentation
Increasing pain and swelling of the wrist. History of very old trauma.
Patient Data
Age: 65 years
Gender: Male
From the case:
Scapholunate advanced collapse (SLAC)
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Frontal view:
- loss of parallelism of the first and second carpal arcs of Gilula
- the radiolunate articulation is widened
- advanced degenerative arthritis in the radioscaphoid and capitolunate articulations
- collapse of mid-carpal joint
Lateral view:
- loss of alignment radius-lunate-capitate-3rd metacarpal
- dorsal tilting of the lunate with dorsal subluxation of the capitate
- the findings are compatible with a dorsal intercalated segmental instability (DISI) deformity
From the case:
Scapholunate advanced collapse (SLAC)
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On the frontal view:
- stylo-scaphoid osteoarthritis
- radio-scaphoid osteoarthritis
- capitolunate osteoarthritis
On the lateral view:
- dorsal tilting of the lunate with dorsal subluxation of the capitate
- DISI deformity
Case Discussion
SLAC (scapholunate advanced collapse) refers to a specific pattern of degenerative arthritis and subluxation which results from untreated chronic scapholunate dissociation.
Watson staging is often used by hand surgeons:
- I: osteoarthritis of the articulation between the radial styloid and the scaphoid
- II: osteoarthritis involving the whole radioscaphoid articulation
- III: osteoarthritis of the radioscaphoid and capitolunate articulations
- IV: osteoarthritis of the radiocarpal and intercarpal articulations +/- distal radioulnar joint (DRUJ)
In this case, it is a stage III SLAC wrist.
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