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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
› Author Affiliations 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

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Gupta V, Rijal L, Jawed A. Managing scaphoid fractures. How we do it?. J Clin Orthop Trauma 2013; 4 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 2 Alshryda S, Shah A, Odak S, Al-Shryda J, Ilango B, Murali SR. Acute fractures of the scaphoid bone: Systematic review and meta-analysis. Surgeon 2012; 10 (04) 218-229
    CrossrefPubMedGoogle Scholar
  • 3 Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980; 5 (05) 508-513
    CrossrefPubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Mandaleson A, Tham SK, Lewis C, Ackland DC, Ek ET. Scaphoid fracture fixation in a nonunion model: a biomechanical study comparing 3 types of fixation. J Hand Surg Am 2018; 43 (03) 221-228
    CrossrefPubMedGoogle Scholar
  • 6 Garcia RM, Leversedge FJ, Aldridge JM, Richard MJ, Ruch DS. Scaphoid nonunions treated with 2 headless compression screws and bone grafting. J Hand Surg Am 2014; 39 (07) 1301-1307
    CrossrefPubMedGoogle Scholar
  • 7 Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996; 78 (12) 1829-1837
    CrossrefPubMedGoogle Scholar
  • 8 Putnam JG, Mitchell SM, DiGiovanni RM, Stockwell EL, Edwards SG. Outcomes of unstable scaphoid nonunion with segmental defect treated with plate fixation and autogenous cancellous graft. J Hand Surg Am 2019; 44 (02) 160.e1-160.e7
    CrossrefPubMedGoogle Scholar
  • 9 Bain GI, Bennett JD, MacDermid JC, Slethaug GP, Richards RS, Roth JH. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am 1998; 23 (01) 76-81
    CrossrefPubMedGoogle Scholar
  • 10 Raju PK, Kini SG. Fixation techniques for non-union of the scaphoid. J Orthop Surg (Hong Kong) 2011; 19 (01) 80-84
    CrossrefPubMedGoogle Scholar
  • 11 Jurkowitsch J, Dall'Ara E, Quadlbauer S. et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg 2016; 136 (11) 1623-1628
    CrossrefPubMedGoogle Scholar
  • 12 Goodwin J, Castañeda P, Drace P, Edwards S. A biomechanical comparison of screw and plate fixations for scaphoid fractures. J Wrist Surg 2018; 7 (01) 77-80
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Quadlbauer S, Pezzei C, Beer T. et al. Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg 2019; 139 (02) 281-293
    CrossrefPubMedGoogle Scholar
  • 14 Munk B, Larsen CF. Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion. Acta Orthop Scand 2004; 75 (05) 618-629
    CrossrefPubMedGoogle Scholar
  • 15 Lee SB, Kim HJ, Chun JM. et al. Osseous microarchitecture of the scaphoid: Cadaveric study of regional variations and clinical implications. Clin Anat 2012; 25 (02) 203-211
    CrossrefPubMedGoogle Scholar