Michel Saint-Cyr1, Georgette Oni, Corrine Wong, Milan K Sen, Andrew S LaJoie, Amit Gupta. 1. Louisville, Ky.; and Dallas, Texas From the Department of Surgery, Division of Hand Surgery, University of Louisville School of Medicine; the Christine M. Kleinert Institute for Hand and Microsurgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the School of Public Health and Information Sciences, University of Louisville.
Abstract
BACKGROUND: Percutaneous fixation of fractures of the scaphoid is well documented in the acute setting by both dorsal and volar methods. What is not commonly discussed is the use of this method for delayed unions and nonunions of the scaphoid. The authors present their case series of patients who underwent dorsal percutaneous fixation for delayed union or nonunion of the scaphoid. METHODS: This study retrospectively reviewed eight consecutive patients (six male patients and two female patients) with a delayed union (8 to 12 weeks) or nonunion (≥13 weeks) of the scaphoid waist treated with dorsal percutaneous cannulated screw fixation. The indications for surgery included failure of conservative treatment, pain with loss of wrist mobility, and prevention of long-term osteoarthritis. Exclusion criteria included previous surgery, dorsal intercalated segmental instability, fracture displacement of more than 1.0 mm, osteoarthritis, avascular necrosis, and proximal pole nonunion. RESULTS: The union rate was 100 percent, with an average time to union of 7 weeks for the delayed union group (three of eight) and 13 weeks for the nonunion group (five of eight). No statistically significant difference was found between the preoperative and postoperative radiolunate angles, scapholunate angles, and height-to-length scaphoid ratio. All patients were able to return to their preinjury employment after an average of 10 weeks. CONCLUSION: This pilot study demonstrates that the dorsal percutaneous approach to treatment of delayed union and nonunion of stable scaphoid waist fractures can result in predictable union, with minimal morbidity and complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Percutaneous fixation of fractures of the scaphoid is well documented in the acute setting by both dorsal and volar methods. What is not commonly discussed is the use of this method for delayed unions and nonunions of the scaphoid. The authors present their case series of patients who underwent dorsal percutaneous fixation for delayed union or nonunion of the scaphoid. METHODS: This study retrospectively reviewed eight consecutive patients (six male patients and two female patients) with a delayed union (8 to 12 weeks) or nonunion (≥13 weeks) of the scaphoid waist treated with dorsal percutaneous cannulated screw fixation. The indications for surgery included failure of conservative treatment, pain with loss of wrist mobility, and prevention of long-term osteoarthritis. Exclusion criteria included previous surgery, dorsal intercalated segmental instability, fracture displacement of more than 1.0 mm, osteoarthritis, avascular necrosis, and proximal pole nonunion. RESULTS: The union rate was 100 percent, with an average time to union of 7 weeks for the delayed union group (three of eight) and 13 weeks for the nonunion group (five of eight). No statistically significant difference was found between the preoperative and postoperative radiolunate angles, scapholunate angles, and height-to-length scaphoid ratio. All patients were able to return to their preinjury employment after an average of 10 weeks. CONCLUSION: This pilot study demonstrates that the dorsal percutaneous approach to treatment of delayed union and nonunion of stable scaphoid waist fractures can result in predictable union, with minimal morbidity and complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.