Scaphoid fracture evolving with SNAC (advanced non-union collapse of the scaphoid): treatment with four-corner arthrodesis
Keywords:Orthopedics, Traumatology, Scaphoid, Fracture, SNAC, Four-corner arthrodesis
AbstractBackground: SNAC (Scaphoid Nonunion Advanced Collapse) is one of the complications after scaphoid fractures that is usually treated conservatively. However, it is one of the main causes of arthritis of the wrist, frequently faced by the surgeon of the hand and, in these cases, it must be corrected surgically. Aim: To report a case of SNAC treated surgically with the four-corner arthrodesis technique. Method: This is a single case report of a 60-year-old female patient, caucasian, attended at the Orthopedics and Traumatology Service of the Ana Costa Hospital, located in the city of Santos – SP, Brazil. Case Report: The trauma mechanism resulted from a hyperextension of the wrist, fracturing the scaphoid and evolving with CANS, with advanced collapse of the scaphoid by necrosis. The patient had painful symptoms and limited range of wrist movement. For surgery, after the initial preparation, an “S”-shaped incision was made in the dorsal region of the right wrist of about 9 centimeters. After divulsion by planes, styloid arthrosis and scaphoid pseudoarthrosis were observed. At that moment, the scaphoid was resected and the midcarpal joint was opened using a saw blade. A 1.5 Kirschner wire was used since, during the surgical procedure, it was necessary to perform provisional fixation due to joint instability, positioning the carpal bones for arthrodesis. Milling was then performed, followed by placement of a four-corner arthrodesis plate and passage of five screws, observing good fixation. After this step, a bone graft was used in the focus of the arthrodesis, followed by the removal of the wire, allowing the observation of good positioning of the arthrodesis in the radioscopy. Finally, local hemostasis was performed, cleaning with 0.9% saline solution and suturing in layers, the region being covered with a sterile dressing and plastered splint. Conclusion: Four-corner arthrodesis proved to be an effective surgical technique for treating scaphoid fractures with progression to CNS.
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