title: An alternative treatment option for scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis: early results of a prospective study on the pyrocarbon adaptive proximal scaphoid implant (APSI).
abstract: BACKGROUND
  Scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis are difficult to treat. Options include proximal row carpectomy (PRC), four corner fusion (4CF) and wrist arthroplasty or arthrodesis. However, with inevitable disease progression, a significant proportion of patients undergo total wrist fusion. This reduces function by abolishing wrist movement. We review the preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients from our prospective study and challenge the assumption that there are no surgical alternatives.
  
  
  METHODS
  This study prospectively studied 12 consecutive pyrocarbon Interpositional arthroplasty day cases over 3 years. Patients were assessed using level of pain, ranges of motion, grip strength, key pinch, type of and time to return to work and the disabilities of the arm, shoulder and hand (DASH) score, both preoperatively and postoperatively. Radiographs were also taken and patient satisfaction recorded.
  
  
  RESULTS
  All 12 patients could be contacted and were satisfied with their surgery. There were no immediate, early or late postoperative complications associated with the procedure. Promising results were noted in terms of pain, ranges of motion, grip strength, key pinch, type of and time to return to work, DASH scores, photographs and radiographs. The mean follow-up was 18 months, range between 11 months and 3 years.
  
  
  CONCLUSIONS
  Our early results are encouraging, warrant further and longer studies and support the use of pyrocarbon implants as a primary procedure in what is a generally young and active subgroup of patients.
authors.affiliation: Department of Orthopaedic Surgery, Oxford University Hospitals, UK. zubinjimmydaruwalla@rcsi.ie
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Daruwalla
authors.forename: Kirstenlee
authors.initials: K
authors.lastname: Davies
authors.forename: Ali
authors.initials: A
authors.lastname: Shafighian
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Gillham
mesh_terms: D000328:Adult; D000368:Aged; D019643:Arthroplasty, Replacement / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D011446:Prospective Studies; D011884:Radius / Q000601:surgery*; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000601:surgery*; D013997:Time Factors; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*