Abstract
Purpose We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation
of the scaphoid delayed union or nonunion using a headless bone screw without bone
grafting.
Methods Sixteen patients with delayed union or nonunion of the scaphoid were included in
this retrospective study between 2006 and 2011. All patients had a delayed presentation
of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients
with bone graft, sclerotic bone debridement, or displacement of the fragment at the
nonunion site were excluded. A percutaneous transtrapezial fixation technique was
used in all cases. Patients were reviewed until clinical and radiographic union was
observed. At the final follow-up, DASH (Disabilities of the Arm, Shoulder and Hand)
and PRWHE (Patient-Rated Wrist and Hand Evaluation) outcome scores were completed.
Results Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow-up
of 36 months (range: 12–98 months). No complications from the percutaneous technique
were noted. The average DASH score was 6 (range: 0–39) and the average PRWHE score
was 10 (range: 0–56). No statistical significant difference in range of motion and
grip strength was found between the operated side and the contralateral side.
Conclusion Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid
fractures without bone grafting is promising. At a mean of 4 months, 94% union was
obtained with good functional results when there was no sclerosis, minimal osteolysis,
and no displacement at the scaphoid nonunion site.
Type of Study Therapeutic study.
Level of Evidence IV.
Keywords
scaphoid fractures - delayed union - percutaneous fixation - consolidation
