Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 5 Issue 7

Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

Paulo Cunha1,3*, Jóni Nunes1,3, Melanie Ribau1, Guilherme Correia1, Tiago Barbosa1, César Correia1, Guilherme França1,2, Elisabete Ribeiro1,2, Juvenália Ribeiro1, Pedro Varanda1,4 and Luís Filipe Rodrigues1,2

1Serviço Ortopedia e Traumatologia do Hospital de Braga, Braga, Portugal
2Trofa Saúde Hospitais, Portugal
3Futebol Clube de Vizela Medical Department, Vizela, Portugal
4Instituto CUF, Porto, Portugal

*Corresponding Author: Paulo Cunha, Serviço Ortopedia e Traumatologia do Hospital de Braga, Braga, Portugal.

Received: April 25, 2022; Published: June 13, 2022


Objective: We intend to demonstrate the functional results of a patient with post-traumatic radiocarpal arthrosis due to a scaphoid nonunion advanced collapse who underwent surgical treatment with proximal row carpectomy and capitate resurfacing with pyrocarbon implant.

Material and Methods: A 51-year-old male patient, working as a sculptor, presented to our consultation with a scaphoid nonunion advanced collapse due to a non-treated scaphoid fracture 20 years before. Clinically he had pain and radiocarpal instability. Radiographically, there was collapse of the scaphoid and lunate, advanced radiocarpal osteoarthritis and proximal migration of capitate. In 2018, he underwent proximal row carpectomy and capitate resurfacing with pyrocarbon implant through a dorsal approach. The patient was immobilized with a wrist cast for 4 weeks. physical rehabilitation started after remove of the cast. Unrestrained activities were allowed at 12 weeks after surgery. Every 6 months the patient was observed in our consultation.

Results: After two and a half years of follow-up, the patient presents a presented a significant improvement on wrist pain, with an initial Visual Analogue Scale score of 9/10 and a current one of 3/10 and a satisfactory wrist mobility, with approximately 20º of extension and 30º of flexion, which allows the execution of his work activity. He refers, however, to a decrease in grip strength. On reassessment radiographs, there is a periprosthetic radiolucent line of 1mm, with progression of radiocarpal arthrosis.

Conclusion: Post-traumatic radiocarpal arthrosis has a negative impact on patients' quality of life. There are several surgical treatment options varying from proximal row carpectomy, total wrist prosthesis, partial or total arthrodesis. In the present case, capitate resurfacing with pyrocarbon implant associated with proximal row carpectomy proved to be a good surgical option, with satisfactory results, especially in the reduction of pain, providing the patient wrist mobility compatible with the daily living activities.

Keywords: Scaphoid Fracture; Scaphoid Nonunion; Wrist Arthritis; Proximal Row Carpectomy; Capitate; Pyrocarbon Implant


  1. Laulan J., et al. “Wrist osteoarthritis”. Orthopaedics and Traumatology: Surgery and Research 1 (2015): S1-9.
  2. Rollo G., et al. “The Advantages of Type III Scaphoid Nonunion Advanced Collapse (SNAC) Treatment With Partial Carpal Arthrodesis in the Dominant Hand: Results of 5-year Follow-up”. Medical Archives (Sarajevo, Bosnia Herzegovina)4 (2018): 253-256.
  3. Fulchignoni C., et al. “Resurfacing capitate pyrcarbon implant after proximal row carpectomy: A literature review camillo fulchignoni daniele caviglia lorenzo rocchi”. Orthopedic Reviews (Pavia)1S (2020): 85-90.
  4. Watson HK and Ballet FL. “The SLAC wrist: Scapholunate advanced collapse pattern of degenerative arthritis”. Journal of Hand Surgery American3 (1984): 358-365.
  5. Vishwanathan K., et al. “Reproducibility of radiographic classification of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist”. Journal of Hand Surgery Europe7 (2013): 780-787.
  6. Bastard C., et al. “Proximal Row Carpectomy with Resurfacing Capitate Pyrocarbon Implant with Bone Graft for Scaphoid Nonunion Advanced Collapse III Wrist with Total Intramedullary Bone Resorption of the Capitate: A Case Report”. Journal of Orthopaedic Case Reports 4 (2018): 35-37.
  7. Goubier JN., et al. “Capitate pyrocarbon prosthesis in radiocarpal osteoarthritis”. Techniques in Hand and Upper Extremity Surgery 1 (2011): 28-31.
  8. Marcuzzi A., et al. “The use of a pyrocarbon capitate resurfacing implant in chronic wrist disorders”. Journal of Hand Surgery Europe6 (2014): 611-618.
  9. Giacalone F., et al. “Resurfacing capitate pyrocarbon implant versus proximal row carpectomy alone: A comparative study to evaluate the role of capitate prosthetic resurfacing in advanced carpal collapse”. Plastic and Reconstructive Surgery 5 (2017): 962-970.
  10. Ferrero M., et al. “Salvage of advanced carpal collapse: proximal row carpectomy with pyrocarbon resurfacing of the capitate versus four-corner arthrodesis”. Journal of Hand Surgery Europe7 (2020): 687-692.
  11. Berger R. “New dorsal capsulotomy for the surgical exposure of the wrist”. Annals of Plastic Surgery 35 (1995): 54-59.
  12. Herren DB., et al. “Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results”. Journal of Hand Surgery American 6 (2006): 643-651.
  13. Ribeiro E., et al. “Pyrocarbon Implant for Trapeziometacarpal Arthritis: Mid-term Clinical and Radiological Results”. Revista Iberoamericana de Cirugía de la Mano 01 (2021): 037-045.
  14. Kompoliti E., et al. “SLAC and SNAC Wrist: The Top Five Things That General Radiologists Need to Know”. Tomography4 (2021): 488-503.
  15. Shah CM and Stern PJ. “Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis”. Current Reviews in Musculoskeletal Medicine 1 (2013): 9-17.
  16. Scott W Wolfe., et al. “GREEN’S OPERATIVE HAND SURGERY, SEVENTH EDITION. Seventh. Scott W. Wolfe, Robert N. Hotchkiss WCP, editor. Elsevier Inc 1 (2017): 588-652.
  17. Green DP., et al. “Proximal Row Carpectomy”. Journal of Hand Surgery American8 (2015): 1672-1676.


Citation: Paulo Cunha., et al. “Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up".Acta Scientific Orthopaedics 5.7 (2022): 43-48.


Copyright: © 2022 Paulo Cunha., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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