Post-traumatic<unk>  can be treated conservatively or with a surgical intervention. In many patients, a conservative (non-surgical) approach is sufficient. Because osteoarthritis is progressive and symptoms may get worse, surgical treatment is advised in any stage. Stage I For stage I, normally, nonsurgical treatment is sufficient. This type of therapy includes the use of splint or cast immobilization, injections of corticosteroid in the pain causing joints and the use of a systemic non-steroidal anti-inflammatory drug to reduce pain and improve the functional use of the affected joint. However, the amount of pain that can be suppressed by nonsurgical therapy is limited and with the progression of the<unk>  surgical treatment is inevitable. In stage I surgical treatment often consists of neurectomy of the posterior interosseous nerve and is often combined with other procedures. In the case of a SLAC, the scapholunate ligament can be reconstructed in combination with a radial styloidectomy, in which the radial styloid is surgically removed from the distal radius. In the case of a SNAC, the scaphoid can be reconstructed by fixating the scaphoid with a screw or by placing a bone graft(Matti-Russe procedure) to increase the stability of the scaphoid. Four corner arthrodesis Stage II In the treatment of stage II<unk> , there are two treatment options that have proved to be most successful. The first treatment option is proximal row carpectomy. During this surgical intervention the proximal row of the carpal bones is removed (scaphoid, lunate, triquetrum, pisiform). It is important that the radioscaphocapitate ligament is left intact, because if the ligament is not preserved the capitate bone will translate to the ulnar side of the<unk>  and move away from the distal radius. The new formed joint between the capitate and the lunate fossa of the distal radius is not as congruent as the former scaphoid-lunate-radius joint, however the results of proximal row carpectomy are generally excellent. In patients older than 40 years proximal row carpectomy is preferred because these patients have a small chance of developing osteoarthritis in the new formed capitate-radial joint during their remaining life. Patients younger than 40 years have a big chance to develop osteoarthritis in the radiocapitate joint. These patients have longer to live, therefore the incongruence of the joint will exist for a longer time. Thus, in this patient population four-corner arthrodesis is the treatment of first choice. The capitate, lunate, hamate and triquetrum are bounded together in this procedure and the scaphoid is excised. Before the arthrodesis is executed, the lunate must be reduced out of DISI position. Because the radiolunate joint is typically preserved in stage II SLAC and SNAC<unk> s, this joint can be the only remaining joint of the proximal<unk> . Both procedures are often combined with<unk>  denervation, as described in the text of treatment stage I. Stage III The only treatment option for stage III<unk>  is four-corner arthrodesis, as described above in stage II. Proximal row carpectomy is not an option, because in stage III patients the capitate is already affected by the osteoarthritis. So, this procedure would merely lead to a new painful joint. Stage IV In this stage there are two surgical treatment options; total<unk>  arthroplasty and total<unk>  arthrodesis. Total<unk>  arthrodesis has become the standard surgical treatment for patients with stage IV<unk> . During this procedure the carpal bones are all fused together and are then fastened to the distal radius. Patients who still want to undertake heavy labor benefit the most of this surgical approach, because after surgery and recovery this is still possible. However, the arc of motion is extremely diminished by this type of surgery. The best option for those who wish for a motion-sparing procedure is total<unk>  arthroplasty. However, impact loading should be avoided, an object heavier than 4.5 kg should not be lifted. So, this surgical approach has postoperative activity restrictions. Nevertheless, patients with a total<unk>  arthrodesis on one side and a total<unk>  arthroplasty on the other, prefer the total<unk>  arthroplasty. The procedure exists of a couple of elements. First, the proximal row is removed and the distal row is fastened to the metacarpals. Then, one side of the arthroplasty is placed upon the distal row and the other side on the distal radius. Additionally, the head of the ulna is removed.
Wrist osteoarthritis
Trapeziometacarpal osteoarthritis
Back strain
Tarsal tunnel syndrome
Elbow fracture
Sprained ankle
Radial scar
Heel pad syndrome