Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

Eun Sun Moon; Myung Sun Kim; Il Kyu Kong; Min Sun Choi

doi:10.12671/jkfs.2010.23.1.69

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Moon, Kim, Kong, and Choi: Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2010; 23(1): 69-75.

Published online: 15 July 2010

DOI: https://doi.org/10.12671/jkfs.2010.23.1.69

Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

Eun Sun Moon, M.D., Myung Sun Kim, M.D., Il Kyu Kong, M.D., Min Sun Choi, M.D.

Department of Orthopedic Surgery, Chonnam National University School of Medicine, Gwangju, Korea.

Address reprint requests to: Il Kyu Kong, M.D. Department of Orthopedic Surgery, Chonnam National University School of Medicine, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-227-1640, Fax: 82-62-225-7794, kongilkyu@gmail.com

Received 22 July 2009 Revised 30 September 2009 Accepted 6 December 2009

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors.

Materials and Methods

Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated.

Results

Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery.

Conclusion

Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.

Keywords: Scaphoid nonunion, Internal fixation, Bone graft

Figures and Tables

Fig. 1

Fragment ratio. Horizontal lines were drawn to define the extent of the fragment. The middle of the fragment was identified and a midline was drawn connecting the two horizontal lines. The lengths of these lines (P, D) were measured to determine the fragment size (P: Proximal fragment, D: Distal fragment).

Fig. 2

(A) Radiographs of 22 years old male shows slightly proximally located nonunion of scaphoid.

(B) Serial follow-up radiographs and (C) computer tomography at postoperative 8 month show failure of healing process.

Fig. 3

(A) Radiographs of 47 years old male shows proximally located nonunion of scaphoid.

(B) Computer tomography demonstrates cystic change of nonunion site and degenerative change of radial styloid and radioscaphoid joint.

(C) Serial follow-up radiographs show failure of healing process at 4 months postoperatively.

Fig. 4

(A) Radiographs of 16 years old female shows suspicious finding of distally located nonunion of scaphoid.

(B) Computer tomography demonstrates cystic change of nonunion site.

(C) Serial follow-up radiographs show complete union at about 12 weeks after surgery.

Table 1

Summary of cases

OV: Openvolar approach, OD: Open dorsal approach, P: Percutaneous approach, ^*p<0.05, ^†p>0.05.

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