When dislocation occurs in the wrist . immobilization in a long arm thumb spica cast. Barton's. Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) Chauffer's. Fracture of radial styloid. What is the appropriate surgical treatment at this time? Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Urgent reduction and surgical repair of disrupted ligaments is required to prevent long-term joint dysfunction. You can rate this topic again in 12 months. Epidemiology. Two-point discrimination is now >10mm in these fingers. - it differs from Colles' or Smith's Fracture in that the dislocation is the most striking radiographic finding; - volar Barton's is more common than dorsal Barton frxs; - mechanism: - usually result from a fall upon an outstretched arm, leading to dorsiflexion stress and tension failure of volar lip of radius; - tenderness of dorsal lunate may suggest Keinbock's dz, while moreulnar tenderness suggests tears of TFC or lunotriquetral ligament; You can rate this topic again in 12 months. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. In lunate dislocations, disruption of Gilula's arcs can be appreciated with disruption of spaces between the proximal and distal carpal bones. A 45-year-old male injures his wrist during Live Action Role Play in Chicago two weeks ago. The patient recovered well initially but presents after 6 months with grip weakness. Extensor carpi radialis longus transfer to extensor pollicus longus, Extensor pollicis brevis transfer to extensor pollicus longus, Extensor indicis proprius transfer to extensor pollicus longus, Primary repair of extensor pollicus longus. Lunate fracture. Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, 23-Year-Old Skateboarder Falls On An Outstretched Arm With A Scapholunate Full-Thickness Tear: All Those Procedures To Repair Don't Work, I Have The Answer: 'RASL' Dazzle: I Am Not Dead Yet, Look At My Long-Term Results - Melvin P. Rosenwasser, MD, Modified Brunelli for Scapholunate Reconstruction, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Wrist Scapholunate (SL) Ligament Injury in 52M. 2.0 screw for a Scaphoid Hand Fracture How to palpate the . Copyright 2023 Lineage Medical, Inc. All rights reserved. (SBQ17SE.13) In the early stages of this disease, the x-rays may be normal and other tests are needed to confirm the diagnosis. Lunate fractures are relatively uncommon, representing about 4 percent of all carpal bone injuries [ 1-4 ]. Deciding whether a fracture needs reducing. A 25-year-old female falls from her horse and injures her left wrist. Which of the following radiographic views shown in Figures A to E would be most helpful in establishing the diagnosis? They often are not diagnosed initially and present delayed as lunate osteonecrosis, which is also known as Kienbock disease. The lunate is displaced and rotated volarly. Epidemiology. FOOSH), high incidence of distal radius fractures in women > 50 years old, DEXA scan is recommended for women with distal radius fractures, fall on outstretched hand (FOOSH) is most common in older population, higher energy mechanism more common in younger patients, includes the radial styloid and scaphoid fossa, attachment sites for the brachioradialis tendon, long radiolunate ligament, and radioscaphocapitate ligament, serves as a buttress to resist radial carpal translation, functions as a load-bearing platform for activities performed with the wrist in ulnar deviation, holds the carpus out to length radially, allowing a more uniform distribution of load across the scaphoid and lunate facets, serves as an anchor for the radioscaphocapitate ligament that prevents ulnar translation of the carpus, transmits load from the carpus to the forearm, based on joint involvement (radiocarpal and/or radioulnar) +/- ulnar styloid fracture, divides intra-articular fractures into 4 types based on displacement, Depressed fracture of the lunate fossa of the articular surface of the distal radius, Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx), Low energy, dorsally displaced, extra-articular fx, Low energy, volarly displaced, extra-articular fx, usually a fall onto outstretched hand (FOOSH), Dorsal angulation < 5 or within 20 of contralateral distal radius, dorsal angulation < 5 or within 20 of contralateral distal radius, extra-articular fracture with stable volar cortex, 82-90% good results if used appropriately, radiographic findings indicating instability (pre-reduction radiographs best predictor of stability), dorsal angulation > 5 or > 20 of contralateral distal radius, displaced intra-articular fractures > 2mm, associated ulnar styloid fractures do not require fixation, articular margin fractures (dorsal and volar Barton's fractures), the volar ulnar corner (critical corner) supports the volar lunate facet with its strong radiolunate ligament attachments, failure to address this fragment can result in volar carpal subluxation, comminuted and displaced extra-articular fractures (Smith's fractures), progressive loss of volar tilt and radial length following closed reduction and casting, medically unstable patients unable to undergo a lengthy procedure, important adjunct with 80-90% good/excellent results, therefore usually combined with percutaneous pinning technique or plate fixation, apply longitudinal traction and volar/dorsal pressure to the distal fracture fragment, avoid positions of extreme flexion and ulnar deviation (Cotton-Loder Position), no significant benefit of physical therapy over home exercises for simple distal radius fractures treated with cast immobilization, radial shortening is the most predictive of instability, followed by dorsal comminution, dorsal comminution > 50%, palmar comminution, intraarticular comminution, higher loss of reduction with 3 or more of LaFontaine criteria, Meta-analyses and systematic reviews demonstrate no difference in functional outcomes between closed treatment versus operative methods in elderly patients (>65 years old), K wires are placed dorsally into the fracture and used as reduction tools until they are driven into the proximal radius, Rayhack technique with arthroscopically assisted reduction, distal radius extra-articular fracture ORIF with volar approach, distal radius intra-articular fracture ORIF with dorsal approach, associated with plate placement distal to watershed area, the most volar margin of the radius closest to the flexor tendons, can have hyperesthesia over the base of the thenar eminence due to palmar cutaneous nerve injury during retraction of the digital flexor tendons when plating the distal radius, new volar locking plates offer improved support to subchondral bone, intra-articular distal radius fractures with dorsal comminution, can combine with external fixation and percutaneous pinning, volar lunate facet fragments may require fragment-specific fixation to prevent early postoperative failure, screw penetration into the radiocarpal joint or DRUJ, assess intra-articular screws with a 23 degree elevated lateral view, assess dorsal cortex penetration with a skyline view, no benefit of therapist-directed physical therapy compared to home exercise program, distal radius fracture spanning external fixator, distal radius fracture non-spanning external fixator, place radial shaft pins under direct visualization to avoid injury to superficial radial nerve, and excessive volar flexion and ulnar deviation, pin site care comprising daily showers and dry dressings recommended, prevent by avoiding immobilization in excessive wrist flexion and ulnar deviation (Cotton-Loder position), progressive paresthesias, weakness in thumb opposition, paresthesias that do not respond to reduction and last > 24-48 hours, nondisplaced distal radial fractures have a higher rate of spontaneous rupture of the EPL tendon, extensor mechanism is thought to impinge on the tendon following a nondisplaced fracture and causes either a mechanical attrition or a local area of ischemia in the tendon, volar plating with screw fixation that penetrates the dorsal cortex and is proud dorsally, very distal volar plate placement on the radius (distal to watershed line) is associated with FPL rupture, due to physical contact of tendon on plate and subsequent tendinopathy, 90% young adults will develop symptomatic arthrosis if articular stepoff > 1-2mm, delayed procedure associated with higher need for bone grafting and a more difficult procedure, radial shortening associated with greatest loss of wrist function and degenerative changes in extra-articular fractures, AAOS 2010 clinical practice guidelines recommend, early efforts to regain motion of wrist and fingers, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. The lunate is made up of the volar pole, body, and dorsal pole. A 56-year-old male presents to your clinic with a 4-month history of inability to extend the IP joint of his thumb. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Proper . She presents 11 months later with the radiograph seen in Figure A, complaining of significant wrist pain. Lunate dislocationsare an uncommon traumatic wrist injury that require prompt management and surgical repair. Difficult wrist fractures. It can be difficult to diagnose in its earlier stages. Treatment involves immobilization or surgical fixation depending on location, severity and alignment of injury. Perilunate fracture-dislocations of the wrist. The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). Philadelphia : Lippincott Williams & Wilkins, c2005. During postoperative recovery from this injury, what benefit does formal physical therapy have as compared to a patient-guided home exercise program? Follow-up/referral. There is no single cause of Kienbocks disease. (SBQ17SE.75) MR arthrogram of the wrist to assess ligamentous injuries, Type in at least one full word to see suggestions list, Transscaphoid perilunate fracture dislocation management, AO Trauma Hand: Must Know Series HOW I DO IT Perilunate FX-Dislocations, Open reduction of volar lunate dislocation (through dorsal Cape Town approach), Hand Lunate Dislocation (Perilunate dissociation), University of Illinois Orthopaedic Surgery, Lunate Dislocation and Acute Carpal Tunnel Syndrome in 23M. DISI (dorsal intercalated segmental instability), scapholunate dissociation causes the scaphoid to flex palmar and the lunate to dorsiflex, if left untreated the DISI deformity can progress into a, DISI deformity may also develop secondary to distal pole of the scaphoid excision for treatment of STT arthritis, DISI is a form of carpal instability dissociative, c-shaped structure connecting the dorsal, proximal and volar surfaces of the scaphoid and lunate bones, dorsal fiber thickened (2-3mm) compared to volar fibers, dorsal component provides the greatest constraint to translation between the scaphoid and lunate bones, proximal fibers have minimal mechanical strength, Overview of wrist ligaments and biomechanics, acute FOOSH injury vs. degenerative rupture, age, nature of injury, duration since injury, degree of underlying arthritis, level of activity, pain increased with loading across the wrist (e.g. J Hand Surg Am. Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review:. Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Fracture Non-Spanning External Fixator, Distal Radius Fracture Spanning External Fixator, Type in at least one full word to see suggestions list, 7th Annual Frontiers in Upper Extremity Surgery, Nonoperative Treatment of Distal Radius Fractures - Michael Bednar, MD, Dorsal Plating of Radius Fractures - Nader Paksima, DO, MPH, Fragment Specific Fixation Distal Radius Fractures - Mark Rekant, MD, 12th Annual Orthopaedic Trauma: Pushing The Envelope. This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. For more advanced stages, surgery is usually considered. She also complains of some paresthesias in her thumb and index finger. Hand therapy does not change the course of the disease; however, it can help to minimize loss of motion from the disease. Fractures of the normal lunate--isolated or associated with fractures of the scaphoid or radius--are very rare. Which of the following is true post-operatively regarding this patient's ulnar styloid fracture? A 70-year-old woman with known osteoporosis sustains a distal radius fracture of her dominant arm with some metaphyseal comminution. Four months post-injury, he presents to the office with an inability to extend his thumb. A 63-year-old female sustained a distal radius and associated ulnar styloid fracture 3 months ago after being involved in a motor vehicle collision. A 32-year-old inebriated male falls from a mechanical bull at a bar and sustains a closed displaced intra-articular distal radius fracture. Radiographs show a well-fixed fracture in good alignment. Long arm cast above the elbow for 6 weeks, Long arm cast for 3 weeks followed by a short arm cast for 3 additional weeks, Closed reduction and percutaneous pinning. Indications. Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. Capitate fractures account for 1-2% of all carpal fractures 1,2. He is not able to see a physician for 4 months. Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation. Post-operatively she is given a prescription with the goal of mitigating a potential adverse outcome. Thank you. (SBQ17SE.67) whilst on the lateral the capitate no longer sits in the lunate. Radiographs are provided in Figure A. Scapho-lunate advanced collapse arthritis or SLAC occurs as the result of unrecognised injury to the . Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. He undergoes operative treatment of his fracture, and immediate post-op radiographs are shown in Figure C. Two weeks later he presents with significantly increased pain and deformity. Unable to process the form. (SBQ17SE.12) Spontaneous rupture of the extensor pollicis longus tendon is most frequently associated with which of the following scenarios? The most important differential is of other carpal dislocations, particularly: In addition to stating that a lunate dislocation is present, a number of features should be sought and commented upon: ensure that radiolunate alignment is disrupted, and that you are not looking at a perilunate dislocation(stage II carpal dislocation), evaluate and comment on the degree or palmar rotation of the lunate (this can be up to 270 degrees)4, ensure that the capitate remains co-linear with the long axis of the radius, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. A 35-year-old professional football player complains of severe wrist pain after making a tackle. Phalanx Fractures are common hand injuries that involve the proximal, middle or distal phalanx. A fracture to the lunate may also be associated with injury to the TFCC. The lunate is a central bone in the wrist that is important for proper movement and support of the joint (Figure 1). He sustained 2 minor falls over the next 6 years and his wrist pain recurred. Given the lunate's position in the wrist, there is significant overlap from other carpal bones and hence these fractures can be subtle. Lunate Dislocation (Perilunate dissociation) . Patients present with wrist pain following a fall. What joint is first affected if left untreated with subsequent development of a SLAC (scapholunate advanced collapse) wrist? comic book publishers accepting submissions 2022 Likes ; brady list police massachusetts Followers ; nurse injector training Followers ; transfer apple health data to samsung Subscriptores ; night shift vs overnight shift Followers ; big joe's funeral questions and answers A normal wrist without Kienbock's disease. Flashcards. Immediate post-operative radiographs are seen in Figure A. Figures A and B depict the closed injury radiograph of a 79-year-old right-hand-dominant woman who fell on her left wrist. Wheeless' Textbook of Orthopaedics. Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. Lunate Dislocation (Perilunate dissociation). In very early stages, the treatment can be as simple as observation, activity changes, and/or immobilization. 3, Greenberg MI. He initially thought it was a sprain, but presents due to continued pain worsened by push-ups. Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures. 110 West Rd., Suite 227 Telephone: 410.494.4994, Limited open reduction of the lunate facet in comminuted intra-articular fractures of the distal radius, Difficult wrist fractures. Diagnosis requires careful evaluation of plain radiographs. Revista dedicada a la medicina Estetica Rejuvenecimiento y AntiEdad. 2. Type in at least one full word to see suggestions list, Hand Scaphoid Lunate Advanced Collapse (SLAC). Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF. {"url":"/signup-modal-props.json?lang=us"}, Murphy A, Lunate fracture. In this condition, the lunate bone loses its blood supply, leading to death of the bone. At the time the article was created Andrew Murphy had no recorded disclosures. Fourth and fifth proximal/middle phalangeal shaft fractures and select metacarpal fractures. He reports paresthesias in his thumb and index finger. main cause for these lesions is a direct impact against a hard surface with a, 4th or 5th metacarpal base fractures or dislocations, usually required to delineate fracture pattern and determine operative plan, diagnosis confirmed by history, physical exam, and, may be used for extra-articular non-displaced fracture, most fractures are intra-articular and require open reduction, interfragmentary screws +/- k-wires for temporary stabilization, fixation may be obtained with K wires or screws, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). The plate may need to removed once the fracture is healed to reduce the chance of flexor pollicis longus injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor carpi radialis injury, The plate may need to removed once the fracture is healed to reduce the chance of flexor digitorum superficialis index finger injury, The patient should undergo revision fixation as soon as possible, The plate is in appropriate position and will likely never need to be removed. Perilunate dislocations typically occur in young adults with high energy trauma resulting in the loading of a hyperextended, ulnarly deviated hand. (OBQ18.177) It is essentially the same sequela of . AP and lateral radiographs of the wrist are shown in figures A and B respectively. Greenberg's text-atlas of emergency medicine. Copyright 2023 Lineage Medical, Inc. All rights reserved. most common injuries to the skeletal system, distal phalanx > middle phalanx > proximal phalanx, 40-69 years old - machinery is most common, assess for numbness indicating digital nerve injury, assess for digital artery injury via doppler, proximal fragment pulled into flexion by interossei, distal fragment pulled into extension by central slip, apex volar angulation if distal to FDS insertion, apex dorsal angulation if proximal to FDS insertion, diagnosis confirmed by history, physical exam, and radiographs, type III - unstable bicondylar or comminuted, proximal fragment in flexion (due to interossei), distal fragment in extension (due to central slip), extraarticular fractures with < 10 angulation or < 2mm shortening and no rotational deformity, 3 weeks of immobilization followed by aggressive motion, extraarticular fractures with > 10 angulation or > 2mm shortening or rotational deformity, Unstable patterns include spiral, oblique, fracture with severe comminution, Eaton-Belsky pinning through metacarpal head, minifragment fixation with plate and/or lag screws, lag screws alone indicated in presence of long oblique fracture, proximal fragment in flexion (due to FDS), distal fragment in extension (due to terminal tendon), due to inherent stability provided by an intact and prolonged FDS insertion, proximal fragment in extension (due to central slip), results from hyperextension injury or axial loading, unstable if > 40% articular surface involved, represents avulsion of collateral ligaments, usually stable due to nail plate dorsally and pulp volarly, often associated with laceration of nail matrix or pulp, shearing due to axial load, leading to fracture involving > 20% of articular surface, avulsion due tensile force of terminal tendon or FDP, leading to small avulsion fracture, terminal tendon attaches to proximal epiphyseal fragment, nail matrix may be incarcerated in fracture and block reduction, distal phalanx fractures with nailbed injury, dorsal base fractures with > 25% articular involvement, displaced volar base fractures with large fragment and involvement of FDP, predisposing factors include prolonged immobilization, associated joint injury, and extensive surgical dissection, treat with rehab and surgical release as a last resort, Apex volar angulation effectively shortens extensor tendon and limits extension of PIPJ, surgery indicated when associated with functional impairment, corrective osteotomy at malunion site (preferred), metacarpal osteotomy (limited degree of correction), most are atrophic and associated with bone loss or neurovascular compromise, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease). Lunate dislocations typically occur due to a fall on an outstretched hand (or during a motor vehicle injury) where there is forceful dorsiflexion of the wrist 3. A lumberjack in rural Michigan falls 10 feet from an Evergreen branch onto an outstretched arm and develops immediate wrist pain. Rathachai Kaewlai, Laura L. Avery, Ashwin V. Asrani, Hani H. Abujudeh, Richard Sacknoff, Robert A. Novelline. lunate fracture orthobullets Which plating option provides the most appropriate treatment of this fracture? You review his operative note in which the surgeon reports having to apply a volar locking plate in a distal position to secure the difficult intra-articular fracture. Radiographs obtained at the time of injury are shown in Figure A. Volar pole fractures are more commonly observed as the lunate is compressed by the capitate. What is the most appropriate next step in management? A 56-year-old woman sustains the closed injury depicted in Figures A-B. The scaphoid accounts for 95% of de-generative/traumatic arthritis in the wrist, with 55% involving the radioscaphoid joint (SLAC pattern). What is the next most appropriate step in management? At the time of the index operation, there was no distal radioulnar joint instability after plating of the radius. Late treatment of a dorsal transscaphoid, transtriquetral perilunate wrist dislocation with avascular changes of the lunate. Incidence. arthroscopic repair and percutaneous pinning. CT and bone scans may also be used.This is a slow-progressing disease, and patients often have the condition for months or even years before they seek treatment. Kienbock's disease is also known as avascular necrosis (AVN) of the lunate. There may be other associated injuries that require further investigation via cross-sectional imaging 1,2. Thank you. (OBQ10.127) Management should consist of. Which of the following fluoroscopic views is used to assess intra-articular screw penetration during volar fixation of a distal radius fracture? The next best step in management would be: (OBQ12.163) Scaphoid Lunate Advanced Collapse (S-LAC) - Hand - Orthobullets Scapholunate ligament - Wikipedia positive test seen in patients with scaphol-unate ligament injury or patients with liga-mentous laxity, where the scaphoid is no longer constrained proximally and sublux-ates out of the scaphoid fossa resulting in pain; when pressure removed from the Treatment of acute SL ligament injuries may be immobilization versus operative repair/reconstruction depending on degree of displacement. Diagnosis is made clinically with progressive wrist pain and wrist instability with radiographs showing advanced arthritis of the radiocarpal and midcarpal joints (radiolunate joint spared). Which of the following has evidence to support its utility in this clinical situation? A 40-year-old slips on the ice on a wintery Michigan day and sustains a comminuted intra-articular distal radius fracture. The lunate is an important stabilizer of the wrist . Barton's fracture: Dorsal intraarticular fracture which is often associated with dislocation at the radiocarpal joint. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. . Like the scaphoid bone, the lunate also has a tenuous retrograde blood supply off of an interosseus arterial branch, and it has the same inherent risk of poor healing and AVN . Kienbocks disease is most common in men between the ages of 20 and 40. - deviation of more than 15 deg either way between the links of chain may be viewed as lax, diseased, or damaged; - Exam: The lunate is displaced and rotated volarly. FlashCards My DeckMaster Create Card Deck . Summary. The rest of the carpal bones are in a normal anatomic position in relation to the radius. The latter mechanism frequently occurs . He reports having undergone open reduction and internal fixation of a distal radius fracture 1 year prior that healed uneventfully. Examination now reveals dorsal tenderness in the proximal wrist but no snuffbox or ulnar tenderness. It can be caused by multiple factors such as: Damage to the lunate can lead to pain and stiffness. Towson, MD 21204 Diagnosis is made with PA wrist radiographs showing widening of the SL joint. Which of the following distal radius fractures is associated with volar translation of carpus relative to the radial articulation? Adequate maintenance of reduction by non-operative treatment is unsuccesful. (OBQ12.38) 2023 Lineage Medical, Inc. All rights reserved. (OBQ12.168) Toe fractures of this type are rare unless there is an open injury or a high-force crushing or shearing injury. Thieme Medical Pub. proximally and the capitate distally. Data Trace is the publisher of Treatment requires urgent closed versus open reduction and stabilization. He presents to your clinic and given his age and the fracture characteristics, he is taken for open reduction with volar locking plate fixation. The patient undergoes closed reduction and splinting; however, her paresthesias worsen significantly in the next 12 hours. Diagnosis can be confirmed with orthogonal radiographs of the involve digit. At the time the article was last revised Craig Hacking had no recorded disclosures. Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. Classification. Lunate/perilunate dislocations are high energy injuries to the wrist associated with neurological injury and poor functional outcomes. If time has passed since injury, it can also lead to wrist arthritis. He was taken to the local teaching hospital where radiographs were taken, shown in Figures A and B. Scaphoid Lunate Advanced Collapse (SLAC) d. escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate. Radiographs are provided in Figures A-C. Scaphoid Lunate Advanced Collapse (SLAC) d escribes the specific pattern of degenerative arthritis seen in chronic dissociation between the scaphoid and lunate.