Management of scapholunate advanced collapse (SLAC) wrist arthritis remains challenging in physically high-demand patients with primarily salvage options described for advanced SLAC wrist. Microfracture resurfacing of the scaphoid fossa may be a potential option for this condition.

A case of a physically active farmer with advanced SLAC wrist arthritis underwent arthroscopic dorsal capsulodesis of the scapholunate interval, microfracture of the scaphoid fossa chondral defect, and application of cartilage allograft is reported. At 1-year follow-up, there is continued resolution of his wrist pain, and function had improved with increased grip strength and wrist range of motion.

Radioscaphoid microfracture and dorsal capsulodesis for SLAC wrist can be a potential dual-pronged reconstructive strategy for the physically high-demand patient that may obviate the need for salvage procedures.