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CC BY-NC-ND 4.0 · J Wrist Surg 2024; 13(01): 024-030
DOI: 10.1055/s-0043-1768236
Scientific Article

Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation

Robert L. Zondervan 
1   McLaren Greater Lansing Hospital, Department of Orthopedics, Lansing, Michigan
2   Sparrow Hospital, Lansing, Department of Orthopedics, Michigan
3   Michigan State University, College of Osteopathic Medicine, East Lansing, Michigan
,
Jessica R. Childe
4   Tulsa Bone and Joint, Tulsa, Oklahoma
,
Robin Kustasz
1   McLaren Greater Lansing Hospital, Department of Orthopedics, Lansing, Michigan
,
Erich E. Hornbach
2   Sparrow Hospital, Lansing, Department of Orthopedics, Michigan
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Abstract

Background Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation.

Question What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation?

Patients and Methods Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review. Range of motion, strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were obtained. Follow-up X-rays were compared with immediate postoperative X-rays.

Results At a mean follow-up of 88.9 months, thumb palmar abduction and radial abduction were significantly higher on the operative side (p = 0.28 and 0.49, respectively). Extension/flexion arc was significantly lower in the operative wrist (p = 0.148). There was no significant difference between the operative and nonoperative sides with regard to strength. The median postoperative DASH score was 2.9 (interquartile range [IQR]: 8.3). There was no progression of osteoarthritis when immediate postoperative and follow-up X-rays were compared. Radiographic union was observed in six of the seven (85.7%) patients who were able to return to the office for follow-up radiographs. The mean scapholunate and radioscaphoid angles measured on X-rays were within normal anatomic range postoperatively.

Conclusions Using nonvascularized distal radius bone graft and screw fixation in the treatment of scaphoid nonunions with associated AVN has favorable radiologic and functional outcomes and should be considered a viable treatment option for this difficult problem.

Keywords

scaphoid - fracture - AVN - avascular necrosis - wrist - graft

Ethical Review Committee Statement

Informed consent was obtained from all patients for being included in the study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (McLaren Healthcare IRB, Lansing, MI, USA) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

IRB Number: 2013–00229.




Publication History

Received: 11 August 2022

Accepted: 06 March 2023

Article published online:
12 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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