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J Wrist Surg 2021; 10(01): 009-016
DOI: 10.1055/s-0040-1714252
Scientific Article

Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss

Eugene T. Ek
1   Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
2   Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Melbourne, Victoria, Australia
3   Department of Surgery, Monash University, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
,
Paul R. Johnson
1   Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
,
Carmel M. Bohan
1   Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
,
Gayan Padmasekara
1   Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Funding None.
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Abstract

Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss.

Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities.

Results All but one patient was male, and the mean age was 23 years (range, 15–38 years). The average time from initial injury was 16 months (range, 3–144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4–9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic.

Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates.

Level of Evidence This is a Level IV, retrospective case series study.

Keywords

scaphoid fracture - nonunion - fixation - wrist - bone graft

Ethical Approval

This project was approved by the Austin Hospital, Human Research Ethics Committee, HREC No. LNR/15/Austin/186.




Publication History

Received: 13 April 2020

Accepted: 03 June 2020

Article published online:
30 July 2020

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