Distal Closing-Wedge Radial Osteotomy Effective First-Line Treatment for SNAC Wrist: Study

Scaphoid fractures are the most common fractures of the carpus, accounting for 90% of the fractures in the region. The tenuous arterial supply of the scaphoid bone, along with the frequent late diagnosis and displacement, leads to high rates of nonunion, especially in fractures of the proximal pole. Wrist osteoarthritis can lead to mechanical pain, limitation of ROM and decreased strength, being a significant burden on the patient’s life.

Vasileios Giannatos et al conducted a study to showcase the results of closed wedge radial osteotomy on SNAC osteoarthritic wrists, a scarcely reported technique in the literature. It has been published in ‘Indian journal of orthopedics.’

14 patients with varied wrist pathology among SNAC and scaphoid nonunion were treated with closed radial wedge osteotomy at the metaphysis. A detailed clinical examination was performed pre- and postoperatively including PRWE, MMWS, VAS score and ROM. The mean radial angulation was also measured on the pre- and postoperative X-rays.

The key findings of the study were:

• The mean age of patients was 56.7 ± 9.1 years.

• Fourteen patients had SNAC wrist.

• All patients were treated with radial closed wedge osteotomy at the metaphysis and showed excellent healing at the fracture site.

• The mean PRWE and MMWS were improved from 85.3 ± 4.8 to 19.7 ± 24.5 and from 15.8 ± 5.2 to 78.2 ± 22.4, respectively. Statistically significant difference was also noted on the VAS score (from 9.2 ± 0.7 to 2.7 ± 2.2) and ROM.

• The mean radial angulation was reduced from 118.1° ± 1.5° to 107.3° ± 1.9°.

The authors commented – “Knowledge of closed wedged radial osteotomy has been around since 1989 without gaining popularity. However, the literature as well as our own study showed exceptional results in SNAC wrists with excruciating pain, with our patients being able even to return to sports.”

“The closing radial wedge osteotomy presented promising results in our case series regarding ROM and pain. The technique could prove a reliable first-line treatment for patients with debilitating wrist osteoarthritis confined to the scapholunate, as it preserves the ligamentous insertions and the bone stock, maintaining the option for more extensive wrist treatments in the future” the authors concluded. 

For further details on the article refer to:

Case Series: Distal Closing-Wedge Radial Osteotomy for Scaphoid Nonunion Advanced Collapse (SNAC) Wrists

Vasileios Giannatos et al

Indian Journal of Orthopaedics (2025) 59:2142–2148

https://doi.org/10.1007/s43465-025-01456-9