Abstract
Background This article reviews the results of a surgical technique using three iterations of
drilling, autologous cancellous bone grafting (filling), and use of an intraosseous compression screw for the treatment of nondisplaced
or minimally displaced scaphoid delayed unions or nonunions.
Methods Part 1—Cadaveric study: Three cadaveric scaphoids underwent stained cancellous bone
graft packing and headless cannulated compression screw placement using a single iteration
of drilling and graft packing. Three additional scaphoids were allocated to the triple
“drill and fill” group, and underwent three iterations of drilling and graft packing
before screw insertion. Graft particle distribution on mid-sagittal sections was assessed
under fluorescence microscopy. Comparison of normalized areas between the single and
triple “drill and fill” groups was performed using repeated measures ANOVA and Tukey's
post hoc test.
Part 2—Clinical study: Twelve patients with minimally displaced scaphoid delayed unions
and nonunions treated between April 2007 and December 2013 with the triple “drill
and fill” technique were included. The average follow-up was 60.4 weeks. Two fellowship-trained
musculoskeletal radiologists independently reviewed images for fracture healing.
Results By the histomorphometric analysis, there was improved autograft distribution along
the screw tract, particularly within the proximal pole, with three iterations of drilling
and filling. Clinically, 11 of 12 delayed unions and nonunions had healed.
Conclusion Our results support the use of the “drill and fill” technique as an option for the
treatment of select nondisplaced or minimally displaced scaphoid nonunions and delayed
unions at the waist without avascular necrosis of the proximal pole.
Level of Evidence This is a Level IV study.
Keywords
autograft - delayed union - scaphoid nonunion - scaphoid - scaphoid fracture
