الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
There are various forms of wrist osteoarthritis. Most of cases occurs secondary to articular malalignment between scaphoid, lunate and radius (SLAC wrist). It can also progress following scaphoid nonunion (SNAC wrist). Both SLAC and SNAC wrists usually occurs following neglected trauma to the wrist with tear of scapholunate ligament or scaphoid fracture. Consequently, the scaphoid goes into rotary subluxation that disrupts the contact surfaces and shifts the loads to the volar and dorsal aspects of the articulation between scaphoid and radius, leading to destruction and degeneration over time. Wrist pain, swelling, limitation of motion and weak grip are the usual presenting symptoms. The diagnosis is made on plain radiographs. Treatment options vary according to the stage, starting from scaphoid reconstruction with bone grafting and fixation with or without reconstruction of the scapholunate ligament up to total wrist arthrodesis.
The aim of this work was to evaluate the results of treatment of SNAC and SLAC wrists by Three-corner fusion operation (luno-capito-hamate fusion) with excision of the scaphoid and triquetrum.
In this study, 22 patients suffering from SNAC and SLAC wrists were treated by scaphoid and triquetrum excision and three-corner fusion using dorsal wrist approach.
All patients were examined clinically and radiologically on admission. The age of the patients ranged from 22 to 53 years with an average of 36 years. There were 21 males and 1 female. The right side was affected in 16 (72.73%), and the left in 6 patients (27.27%). The dominant hand was affected in 16 patients (72.73%). Seventeen patients (77.28%) were heavy manual workers, four (18.18%) had office job, and one patient (4.5%) was a house wife. The mean duration of symptoms was 48 months.
All patients complained of severe pain during daily activities. Sense of stiffness was mild persistent in 8 patients (36.4%), and severe in 14 patients (63.6%). Four patients (18.2%) had to change their jobs and 18 patients (81.8%) were unable to work. The percentage of affected side grip strength ranged from 42 to 62% with an average of 51.98% from the normal side. Limitation of wrist motion was observed in all patients. The flexion-extension arc ranged from 95 to 142 degrees with a mean of 105.45 degrees, while radial-ulnar deviation arc ranged from 35 to 47 degrees with a mean of 41.18.
At final post-operative assessment, and after 26.4 months mean follow up, the results were excellent in 4 patients (18.2%), good in 5 (22.7%) and fair in 13 patients (59.1%). Six patients (27.3%) were pleased and 16 patients (72.7%) were satisfied. Pain was mild in 13 (59.1%), and moderate in 9 patients (40.9%). Mild occasional sense of stiffness was reported by 10 (45.5%) and mild persistent by 12 patients (54.5%). Those who returned to regular activities were 8 (36.4%), 7 patients (31.8%) modified their duties and 7 patients (31.8) had to change their job. The percentage of grip strength compared with the unaffected side improved to 78% (range 62-98%). Flexion-extension arc ranged from 82 to 134 degrees with a mean of 95.68 degrees, while radial-ulnar deviation arc ranged from 23 to 55 degrees with a mean of 41.18. The final total score increased post-operatively to be range from 13 to 21 points with a mean of 17.05 points, which was significantly different from the pre-operative score.
There was statistically significant relationship between patient hand dominance, duration of symptoms and final outcome. There was no statistically significant relationship between patients gender, age and the final outcome