Stuart G Kirkham1, Michael J Millar. 1. Department of Orthopaedics, Westmead Hospital, Hawkesbury Road, Westmead, Sydney, NSW 2145 Australia.
Abstract
BACKGROUND: Cavitary-type scaphoid non-unions represent one of the most difficult treatment challenges amongst all scaphoid non-unions as they exhibit bone loss, scaphoid shortening, flexion ('humpback') deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. Our technique and its rationale are presented in the largest-to-date series on cavitary scaphoid non-unions exhibiting DISI. METHODS: Our technique for treatment of these cavitary non-unions is presented through a series of 27 patients. RESULTS: Union was achieved in (26/27) 96% of cases, with no complications. Carpal mechanics was restored, with an average carpal height index of 1.52 ± 0.06, and an average scapholunate angle was 46 ± 9°. Average follow-up was 2.2 years. CONCLUSION: In this subset of patients, we believe this technique is less technically demanding than the use of either cortico-cancellous grafts or various compression screws. Our success equals or betters that of other published techniques, with all patients enjoying a full return to work, even in occupations demanding heavy labour. We believe that scaphoid union, coupled with the often difficult restoration of carpal height and intra-carpal angles, has produced very good functional outcomes in the management of these challenging cases.
BACKGROUND: Cavitary-type scaphoid non-unions represent one of the most difficult treatment challenges amongst all scaphoid non-unions as they exhibit bone loss, scaphoid shortening, flexion ('humpback') deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. Our technique and its rationale are presented in the largest-to-date series on cavitary scaphoid non-unions exhibiting DISI. METHODS: Our technique for treatment of these cavitary non-unions is presented through a series of 27 patients. RESULTS: Union was achieved in (26/27) 96% of cases, with no complications. Carpal mechanics was restored, with an average carpal height index of 1.52 ± 0.06, and an average scapholunate angle was 46 ± 9°. Average follow-up was 2.2 years. CONCLUSION: In this subset of patients, we believe this technique is less technically demanding than the use of either cortico-cancellous grafts or various compression screws. Our success equals or betters that of other published techniques, with all patients enjoying a full return to work, even in occupations demanding heavy labour. We believe that scaphoid union, coupled with the often difficult restoration of carpal height and intra-carpal angles, has produced very good functional outcomes in the management of these challenging cases.