PURPOSE: Conventional treatment of scaphoid nonunion with collapse deformity and bone loss involves the use of a structural corticocancellous bone graft. With internal screw fixation, we propose that length and alignment can be restored and maintained using only cancellous interposition graft. METHODS: We describe 12 patients with established scaphoid waist nonunions. Average patient age was 22 years, all were male, and 8 cases involved the dominant wrist. Time from injury to treatment averaged 11 months. We performed open reduction through an anterior approach with correction of the deformity and placement of a distal to proximal screw. We then simply filled the resultant defect with cancellous autograft obtained from the ipsilateral distal radius. All patients underwent postoperative computed tomographic imaging to document union and degree of correction. RESULTS: At a minimum 2-year follow-up, all patients had a united scaphoid with significant improvement in wrist extension compared with preoperative values. Grip strength also improved significantly. Disabilities of the Arm, Shoulder, and Hand scores at follow-up averaged 4 ± 3 (range, 0-9), the Mayo wrist score averaged 88 ± 6 (range, 80-100), and the average lateral intrascaphoid angle improved from 49° to 32° (normal, < 35°). Pain at follow-up as measured on a 10-point visual analog scale averaged 0.3 (range, 0-2). CONCLUSIONS: With stable internal screw fixation, scaphoid waist nonunion with collapse and bone loss can be successfully treated using only cancellous bone graft. Advantages include marked simplification of surgical carpentry, the use of local autograft, and rapid incorporation of cancellous bone without compromise of scaphoid reduction and carpal alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: Conventional treatment of scaphoid nonunion with collapse deformity and bone loss involves the use of a structural corticocancellous bone graft. With internal screw fixation, we propose that length and alignment can be restored and maintained using only cancellous interposition graft. METHODS: We describe 12 patients with established scaphoid waist nonunions. Average patient age was 22 years, all were male, and 8 cases involved the dominant wrist. Time from injury to treatment averaged 11 months. We performed open reduction through an anterior approach with correction of the deformity and placement of a distal to proximal screw. We then simply filled the resultant defect with cancellous autograft obtained from the ipsilateral distal radius. All patients underwent postoperative computed tomographic imaging to document union and degree of correction. RESULTS: At a minimum 2-year follow-up, all patients had a united scaphoid with significant improvement in wrist extension compared with preoperative values. Grip strength also improved significantly. Disabilities of the Arm, Shoulder, and Hand scores at follow-up averaged 4 ± 3 (range, 0-9), the Mayo wrist score averaged 88 ± 6 (range, 80-100), and the average lateral intrascaphoid angle improved from 49° to 32° (normal, < 35°). Pain at follow-up as measured on a 10-point visual analog scale averaged 0.3 (range, 0-2). CONCLUSIONS: With stable internal screw fixation, scaphoid waist nonunion with collapse and bone loss can be successfully treated using only cancellous bone graft. Advantages include marked simplification of surgical carpentry, the use of local autograft, and rapid incorporation of cancellous bone without compromise of scaphoid reduction and carpal alignment. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors: Cary Tanner; Toby Johnson; Alex Majors; Vincent R Hentz; Lisa Husak; Edward Walker Gallego; Brad Christ; Nathan Hoekzema Journal: Hand (N Y) Date: 2018-01-22