Journal List > J Korean Soc Surg Hand > v.19(1) > 1106470

J Korean Soc Surg Hand. 2014 Mar;19(1):19-28. Korean.
Published online March 28, 2014.  https://doi.org/10.12790/jkssh.2014.19.1.19
Copyright © 2014. The Korean Society for Surgery of the Hand
Arthroscopically assisted Cancellous Bone Grafting and Percutaneous K-Wires Fixation for the Treatment of Scaphoid Nonunions
Young-Keun Lee,1 Sang-Hyun Woo,2 Pak Cheong Ho,3 Ji-Gang Park,4 and Joo-Yong Kim5
1Department of Orthopaedic Surgery, Dason Orthopaedic Clinic, Jeonju, Korea.
2Chen and Woo's Institute for Hand Surgery and Reconstructive Microsurgery, W Hospital, Daegu, Korea.
3Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University, Hong Kong.
4Department of Orthopaedic Surgery, Chungbuk National Universiry Hospital, Chungbuk National University College of Medicine, Chungju, Korea.
5Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Correspondence to: Joo-Yong Kim. Department of Orthopaedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea. TEL: +82-51-890-6129, FAX: +82-51-892-6619, Email: trueyklee@naver.com
Received January 02, 2014; Revised February 28, 2014; Accepted February 28, 2014.

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

The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation.

Methods

We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up.

Results

All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up.

Conclusion

Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.

Keywords: Scaphoid nonunion; Arthroscopy; Bone graft; K-wire

Figures


Fig. 1
A 46-year-old male patient with nonunion of the left scaphoid fracture. Preoperative left wrist plain scaphoid (A) view show nonunion at the waist of the scaphoid. (B) Same patient's left wrist, midcarpal arthroscopy image of scaphoid nonunion site shows large gap and sclerotic margins of both fragments. P, proximal fragment; D, distal fragment; MCR, midcarpal radial.
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Fig. 2
Provisional K-wire fixation.
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Fig. 3
(A) Left wrist, midcarpal arthroscopy image which is finished bone graft to the nonunion site percutaneously using cannula and trocar. (B, C) Same patient's left wrist, midcarpal arhroscopy images of percutaneous autogenous iliac cancellous bone grafting at the nonunion site using cannula and trocar. MCR, midcarpal radial.
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Fig. 4
Immediate postoperative plain left wrist anteroposterior (A) and scaphoid (B) radiographs show internal fixation with K-wires and grafted bone at the nonunion site.
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Fig. 5
Postoperative 49 months later follow-up plain left wrist scaphoid (A) and photographs (B, C) show complete bony union and excellent clinical result.
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Tables


Table 1
Treatment classification system for scaphoid nonunion13
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Table 2
Demography of the patients
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Table 3
Demography of the patients
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References
1. Christodoulou LS, Kitsis CK, Chamberlain ST. Internal fixation of scaphoid non-union: a comparative study of three methods. Injury 2001;32:625–630.
2. Schuind F, Haentjens P, Van Innis F, Vander Maren C, Garcia-Elias M, Sennwald G. Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg Am 1999;24:761–776.
3. Barton NJ. Experience with scaphoid grafting. J Hand Surg Br 1997;22:153–160.
4. 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;75:618–629.
5. Chang MA, Bishop AT, Moran SL, Shin AY. The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am 2006;31:387–396.
6. Whipple TL. The role of arthroscopy in the treatment of intra-articular wrist fractures. Hand Clin 1995;11:13–18.
7. Taras JS, Sweet S, Shum W, Weiss LE, Bartolozzi A. Percutaneous and arthroscopic screw fixation of scaphoid fractures in the athlete. Hand Clin 1999;15:467–473.
8. Shih JT, Lee HM, Hou YT, Tan CM. Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures. Arthroscopy 2005;21:620–626.
9. Wong WY, Ho PC. Minimal invasive management of scaphoid fractures: from fresh to nonunion. Hand Clin 2011;27:291–307.
10. Lee YK, Woo SH, Ho PC. Arthroscopic bone grafting and percutaneous k-wires fixation for the treatment of scaphoid nonunion: surgical technique. J Korean Soc Surg Hand 2010;15:93–97.
11. Capo JT, Orillaza NS Jr, Slade JF 3rd. Percutaneous management of scaphoid nonunions. Tech Hand Up Extrem Surg 2009;13:23–29.
12. Chu PJ, Shih JT. Arthroscopically assisted use of injectable bone graft substitutes for management of scaphoid nonunions. Arthroscopy 2011;27:31–37.
13. Slade JF III, Merrell GA, Geissler WB. Fixation of acute and selected nonunion scaphoid fractures. In: Geissler W, editor. Wrist arthroscopy. New York, NY: Springer; 2005. pp. 112-124.
14. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996;78:357–365.
15. Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989;14:594–606.
16. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am 1985;10:597–605.
17. Slade JF 3rd, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res 2006;445:108–119.
18. Slade JF 3rd, 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 Suppl 4:20–32.
19. Zaidemberg C, Siebert JW, Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am 1991;16:474–478.
20. Mathoulin C, Haerle M. Vascularized bone graft from the palmar carpal artery for treatment of scaphoid nonunion. J Hand Surg Br 1998;23:318–323.
21. Harpf C, Gabl M, Reinhart C, et al. Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases. Plast Reconstr Surg 2001;108:664–674.
22. Lim TK, Kim HK, Koh KH, Lee HI, Woo SJ, Park MJ. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting. J Hand Surg Am 2013;38:1906–1912.e1.
23. Kim JS, Yoon JO, Kim E, Lee CC, Kim JM. Pure cancellous chip bone graft and K-wire fixation for undisplaced scaphoid nonunion. J Korean Soc Surg Hand 2008;13:177–181.
24. Robbins RR, Ridge O, Carter PR. Iliac crest bone grafting and Herbert screw fixation of nonunions of the scaphoid with avascular proximal poles. J Hand Surg Am 1995;20:818–831.
25. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 1984;66:114–123.
26. Wozasek GE, Moser KD. Percutaneous screw fixation for fractures of the scaphoid. J Bone Joint Surg Br 1991;73:138–142.
27. Trail IA, Stanley JK. Scaphoid nonunions: predictive factors. In: Slutsky DJ, editor. Principles and practice of wrist surgery. Philadelphia, PA: Saunders Elsevier; 2010. pp. 233-238.
28. Gutow AP. Percutaneous fixation of scaphoid fractures. J Am Acad Orthop Surg 2007;15:474–485.
29. Ritter K, Giachino AA. The treatment of pseudoarthrosis of the scaphoid by bone grafting and three methods of internal fixation. Can J Surg 2000;43:118–124.
30. Chen CY, Chao EK, Lee SS, Ueng SW. Osteosynthesis of carpal scaphoid nonunion with interpositional bone graft and Kirschner wires: a 3- to 6-year follow-up. J Trauma 1999;47:558–563.
31. Takami H, Takahashi S, Ando M. Scaphoid nonunion treated by open reduction, anterior inlay bone grafting, and Kirschner-wire fixation. Arch Orthop Trauma Surg 2000;120:134–138.