Percutaneous Fixation Without Graft vs Open Fixation with Graft in Delayed Stable Consolidation of the Scaphoid: Retrospective Analysis

Abstract

Introduction The most appropriate surgical management of delayed symptomatic scaphoid consolidation remains controversial. Few studies compare different treatment options. This study aimed to compare the outcomes from percutaneous osteosynthesis with no associated bone graft and open reduction and internal fixation with cancellous autograft for stable delayed scaphoid consolidation.

Material and Methods A retrospective study included 24 patients: 13 subjects underwent percutaneous osteosynthesis without graft, while 11 patients underwent open reduction and internal fixation with associated cancellous graft. The main study variable was the average consolidation time in weeks. We determined the following secondary variables before and after surgery. The secondary radiological included the scapholunate angle, scapholunate distance, capitolunate angle, radiolunate angle, scaphoid length, and lateral intrascaphoid angle. The secondary functional variables at 6, 12, and 24 weeks included range of motion in flexion and extension, radial and ulnar deviation, pain according to the visual analog scale (VAS), the Quick Disability of Arm Shoulder and Hand (DASH) questionnaire, and the Patient-Rated Wrist Evaluation (PRWE) score, average number of physical therapy sessions, and average time to return to work. The Mann-Whitney U test analyzed quantitative variables, while the chi-square test analyzed qualitative variables at a significance level set at p < 0.05.

Results The mean time until surgery was 10 weeks in the group without graft and 23 weeks in the group with graft. The mean consolidation time in the group without graft was 10 weeks (range, 8 to 12 weeks) and 12 weeks (range, 8 to 20 weeks) in the group with graft. The consolidation rate was 100% in all cases. Differences favored the group without graft for the following parameters: visual analog scale (VAS) for pain at 3 months (5 vs. 7, p = 0.002), 6 months (3 vs, 6, p = 0.000), and 1 year (1 vs. 2, p = 0.001); DASH at 1 year (9 vs. 24, p = 0.000); PRWE score at 1 year (6 vs. 10, p = 0.011), mean flexion at 6 months (65° vs. 45°, p = 0.010); mean extension at 6 months (70° vs. 46°, p = 0.009); and ulnar deviation at 6 months (25° vs. 15°, p = 0.047). Differences favored the group with graft for the radial deviation at 6 months (15° vs. 12°, p = 0.038). The average time to resume working was 8 weeks in both groups.

Conclusion For surgical treatment of delayed consolidation in scaphoid fractures with no instability, percutaneous osteosynthesis without a bone graft could be superior to open reduction and internal fixation with cancellous autograft regarding radiological consolidation time and functional recovery.

Keywords

scaphoid pseudoarthrosis - percutaneous osteosynthesis - internal fixation - bone graft

Publication History

Received: 31 August 2022

Accepted: 16 August 2023

Article published online:
05 December 2023

• Bibliografía

• 1 Capo JT, Orillaza Jr NS, Slade III JF. Percutaneous management of scaphoid nonunions. Tech Hand Up Extrem Surg 2009; 13 (01) 23-29
• 2 Bilic R, Simic P, Jelic M. et al. Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 2006; 30 (02) 128-134
• 3 De Vitis R, Passiatore M, Perna A, Fioravanti Cinci G, Taccardo G. Comparison of Shape Memory Staple and Gelled Platelet-Rich Plasma versus Shape Memory Staple alone for the Treatment of Waist Scaphoid Nonunion: A Single-Center Experience. Joints 2020; 7 (03) 84-90
• 4 Dedeoğlu SS, İmren Y, Çabuk H, Tekin AC, Türe YC, Gürbüz H. Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting. Hand Surg Rehabil 2018; 37 (01) 43-47
• 5 Cifras JL, Azócar C, Sanhueza M, Cavalla P, Liendo R. Manejo Artroscópico de Pseudoartrosis de Escafoides con Deformidad en Joroba: Técnica Quirúrgica y Serie de Casos. Rev Chil Ortop Traumatol 2019; 60: 47-57
• 6 Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of Scaphoid Nonunion: A Systematic Review of the Existing Evidence. J Hand Surg Am 2015; 40 (09) 1797-1805.e3
• 7 Kim JK, Yoon JO, Baek H. Corticocancellous bone graft vs cancellous bone graft for the management of unstable scaphoid nonunion. Orthop Traumatol Surg Res 2018; 104 (01) 115-120
• 8 Taleb C, Bodin F, Collon S, Gay A, Facca S, Liverneaux P. Retrograde percutaneous screw fixation for scaphoid type II non-union in Schernberg zones 2 to 4: a series of 38 cases. Chir Main 2015; 34 (01) 32-38
• 9 Tada K, Ikeda K, Nakada M, Matsuta M, Murai A, Tsuchiya H. Screw fixation without bone grafting for scaphoid fracture nonunion. J Clin Orthop Trauma 2020; 13: 19-23
• 10 Hegazy G. Percutaneous Screw Fixation of Scaphoid Waist Fracture Non-Union Without Bone Grafting. J Hand Microsurg 2015; 7 (02) 250-255
• 11 Belloti JC, Vasconcelos KBL, Raduan Neto J, Okamura A, Fernandes M, de Moraes VY. Percutaneous Fixation without Bone Graft for Scaphoid Nonunion. Rev Bras Ortop 2020; 55 (06) 759-763
• 12 Slade III JF, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res 2006; 445 (445) 108-119
• 13 Mahmoud M, Koptan W. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. J Bone Joint Surg Br 2011; 93 (07) 932-936
• 14 Ernst SMC, Green DP, Saucedo JM. Screw Fixation Alone for Scaphoid Fracture Nonunion. J Hand Surg Am 2018; 43 (09) 837-843
• 15 Vanhees M, van Riet RRP, van Haver A, Kebrle R, Meermans G, Verstreken F. Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist. J Wrist Surg 2017; 6 (03) 183-187
• 16 Capo JT, Shamian B, Rizzo M. Percutaneous screw fixation without bone grafting of scaphoid non-union. Isr Med Assoc J 2012; 14 (12) 729-732
• 17 Slade III JF, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 20-32
• 18 Elgayar L, Elmajee M, Aljawadi A, Abdelaal A, Khan S, Pillai A. A systematic review of mechanical stabilization by screw fixation without bone grafting in the management of stable scaphoid non-union. J Clin Orthop Trauma 2021; 17: 112-117
• 19 Gvozdenovic R, Joergensen RW, Joerring S, Jensen CH. Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone. J Wrist Surg 2020; 9 (01) 13-18
• 20 Liu B, Wu F, Ng CY. Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting. J Hand Surg Eur Vol 2019; 44 (06) 594-599