Review Question - QID 219520

This 70-year-old male with right wrist pain demonstrates a stage II SNAC wrist and is indicated for a proximal row carpectomy (PRC) given his age and comorbidities. Preservation of the radioscaphocapitate (RSC) ligament is most important to maintain the stability of the carpus and prevent ulnar translation.

Scaphoid non-union advanced collapse (SNAC) and scaphoid lunate advanced collapse (SLAC), although different in respect to pathophysiology, confer similar results (radiocarpal/carpal osteoarthritis) secondary to altered wrist biomechanics. As early disease (arthritis focal to the radial styloid) typically remains subclinical, most patients present with advanced disease, possessing radiocarpal and/or intercarpal osteoarthritis. Depending on several factors (age, comorbidities, occupation, location of arthritis), patients are presented with surgical options of either scaphoidectomy with four-corner fusion or PRC. Concerning PRCs, maintaining the RSC is crucial to avoid destabilizing the wrist and allow for ulnar translation of the carpus.

Alta et al. present a case report of a 36-year-old male who sustained radioscaphocapitate ligament rupture following a fall, which resulted in isolated ulnar translation of the carpus. The injured ligament was subsequently treated with reconstruction utilizing the brachioradialis (BR) tendon, improving wrist stability and function. The authors conclude utilizing the BR tendon can confer good outcomes and believe performing acute reconstruction portends the best outcomes.

Werner et al. performed a cadaver study examining the degree of scaphoid and lunate translation following scapholunate interosseous ligament (SLIL) and either two dorsal (dorsal intercarpal, dorsal radiocarpal) or two volar (scaphotrapezial, RSC) ligament transection. The authors noted increased motion of both the scaphoid and lunate with both dorsal and volar ligament sectioning, particularly in the radio-ulnar direction, although translation was limited to less than 2 mm. The authors conclude for significant translation of the carpus, injury to more than SLIL and volar or dorsal ligaments is required.

Maschke et al. performed a cadaver study examining eight upper extremity limbs, examining the effect of the BR tendon reconstruction following the complete release of the palmar or dorsal radiocarpal ligaments. The authors found a mean increase of 7.3 mm of ulnar translation followiD