Of the many patterns of wrist osteoarthrosis, the SLAC wrist (scapholunate advanced collapse pattern) is one of the commonest. The main cause of osteoarthrosis is the pathological palmar flexion and dorsal subluxation of the scaphoid. The main cause of osteoarthrosis is the pathological to a decrease in the joint contacts between the scaphoid and the radius. The resulting excessive articular stresses cause the osteoarthrosis, first involving the radioscaphoid joint. The lunate dorsal flexion seems to have little consequences at the level of the radiolunate joint. The principal objective of the treatment is therefore to correct the malposition of the scaphoid, before the occurrence of chondral degeneration. This can be achieved by the technique of Brunelli, where a band of the Flexor carpi radialis tendon, still attached to the base of the second metacarpal, is tunnelled through the distal pole of the scaphoid and anchored to the dorso-ulnar radius. The method is described and the results discussed. The original technique of Brunelli seems to achieve better reduction of the scaphoid than the derived techniques, including the three-ligament tenodesis (3LT).
