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Kang, Koh, Choi, Kim, and Park: Preservation of Scaphoid in Scaphoid Nonunion Advanced Collapse Stage II and III
Original Article

Journal of the Korean Orthopaedic Association 2016; 51(2): 125-132.

Published online: 22 April 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.2.125

Preservation of Scaphoid in Scaphoid Nonunion Advanced Collapse Stage II and III

Ho-Jung Kang, M.D., Ph.D., Il-Hyun Koh, M.D., Yun-Rak Choi, M.D., Ph.D., Ji-Sub Kim, M.D., Young-Chang Park, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Correspondence to: Ho-Jung Kang, M.D., Ph.D. Department of Orthopaedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea TEL: +82-2-2019-3412, FAX: +82-2-573-5393, Kangho56@yuhs.ac

Received 22 June 2015       Revised 26 July 2015       Accepted 22 August 2015

Copyright © 2016 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to investigate the outcome of open reduction and internal fixation with a headless screw and auto iliac bone graft for patients of scaphoid nonunion advanced collapse (SNAC) stage II and III.

Materials and Methods

A retrospective analysis was conducted for 10 patients diagnosed with stage II or III SNAC, and consequently treated with open reduction and internal fixation with a headless screw and auto iliac bone graft with or without radial styloidectomy between 2010 and 2013. Radiographic results were evaluated by bone union, the scapholunate angle and lateral intrascaphoid angle. Clinical results were evaluated by range of motion, pain, grip strength, Mayo wrist score, and assessment of Maudsley.

Results

All patients showed union after the operation. Final follow-up X-rays show smoothening of the articular surface with improvement of sclerotic lesions of the articular surface, cystic lesions and osteopenic lesions. Pain decreased after the operation compared with preoperative status, grip strength and Mayo wrist score showed significant improvement. Scapholunate angle and lateral intrascaphoid angle decreased after the operation, but it was not significant. According to assessment of Maudsley, among 10 cases, there were 4 excellent cases, 4 good cases and 2 fair cases.

Conclusion

Restoration of stability of scaphoid is important to SNAC stage II and III, open reduction and internal fixation with a headless screw and auto iliac bone graft shows satisfactory clinical and radiologic outcomes. Thus it is considered a recommendable operation.

Keywords: scaphoid bone, scaphoid nonunion advanced collapse, scaphoid nonunion advanced collapse stage II & III, headless screw fixation and auto iliac bone graft

Figures and Tables

Figure 1

A 55-year-old male patient. Scaphoid nonunion advanced collapse (SNAC) stage II. (A) Preoperative radiograph showed SNAC stage II. (B) Preoperative computed tomography (CT) scan showed sclerosis and cystic lesion around scaphoid. (C) Radiograph at 1 year after the operation (dorsal ante-grade 1 headless screw and miniscrew fixation with auto iliac corticocancellous bone graft and styloidectomy) showed bone union and smoothening of the articular surface. (D) CT scan at 8 months after the operation showed a decrease of sclerosis and cystic lesions.

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Figure 2

A 59-year-old male patient. Scaphoid nonunion advanced collapse (SNAC) stage III. (A) Preoperative radiograph showed SNAC stage III. (B) Preoperative computed tomography (CT) scan showed multiple cystic lesion on lunate and capitate bone, and bony spur at the radial styloid process. (C) Radiograph at 1 year after the operation (dorsal ante-grade two headless screw fixation with auto iliac cancellous bone graft and styloidectomy) showed bone union. (D) CT scan at 6 months after the operation showed a significant decrease of cystic lesions, sclerosis, and bone union.

jkoa-51-125-g002
Table 1

Summary of Cases

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All subjects are male. SNAC, scaphoid nonunion advanced collapse; W, waist; P, proximal; VAF, volar ante-grade fixation; RS, radial styloidectomy; DAF, dorsal ante-grade fixation; DRF, dorsal retro-grade fixation; MS, miniscrew; HCS, headless compression screw.

Table 2

Clinical and Radiologic Outcomes

jkoa-51-125-i002

VAS, visual analogue scale; SLA, scapholunate angle; LISA, lateral intrascaphoid angle. *p<0.05 statistically significant.

Table 3

Clinical Outcome (by Maudsley and Chen)

jkoa-51-125-i003
Table 4

Postoperative Complication

jkoa-51-125-i004

AVN, avascular necrosis.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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