Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

Jin-Ho Lee; Myung-Sun Kim

doi:10.12790/jkssh.2014.19.1.36

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Lee and Kim: Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2014;19(1):36-43.

Published online: 11 March 2014

DOI: https://doi.org/10.12790/jkssh.2014.19.1.36

Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

Jin-Ho Lee, Myung-Sun Kim

Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea

Correspondence to: Myung Sun Kim, Department of Orthopedics Surgery, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea, TEL: +82-62-227-1640, FAX: +82-62-225-7794, E-mail: mskim@jnu.ac.kr

Received 29 January 201412 March 2014 Accepted 24 March 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:

We evaluated clinical and radiographic results of the pure cancellous bone grafting and internal fixation for the treatment of scaphoid waist nonunions with humpback deformity.

Methods:

The subject of this study were 46 patients who had a scaphoid waist nonunion with humpback deformity treated with bone grafting between January 2005 and December 2011. The average follow-up period was 18.6 months (range, 12-26 months). We performed open reduction through an anterior approach with correction of the deformity and insertion of a screw from distal to proximal. We filled the resultant defect with pure cancellous autograft. The clinical results were evaluated with range of motion of the wrist joint, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score and visual analogue scale. For radiographic evaluation, we assessed lateral scapholunate angle and intrascaphoid angle.

Results:

Bony union was achieved in 39 out of 46 patients (84.8%). DASH score significantly improved from 24.0 to 7.3 postoperatively. The modified Mayo wrist score also increased from 64.8 to 88.6 postoperatively. There were 17 excellent results 18 good results. The average scapholunate angle and intrascaphoid angle improved from 70.6°, 51.5° to 52.4°, 33.9° postoperatively.

Conclusion:

Pure cancellous bone grafting and internal fixation provide good clinical result in patients with a scaphoid waist nonunion with successful restoration of the humpback deformity.

Keywords: Scaphoid, Nonunion, Humpback deformity, Cancellous bone graft

References

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Fig. 1.

(A) Preoperative radiographs shows nonunion of scaphoid waist. (B) Computed tomography shows scaphoid nonunion and humpback deformity.

Fig. 2.

Intraoperatively. (A) The leading part of the pin was anchored in the center of the proximal pole with it completely across the bone graft. (B) The final axis of the pin was parallel to the volar surface of the scaphoid.

Fig. 3.

(A) One year after surgery radiographs showed union of scaphoid waist fracture. (B) on computed tomography scan, humpback deformity was corrected.

Table 1.

Clinical results

Clinical results	Preoperative	Postoperative (last follow-up)	p-value
Wrist flexion	69.8±10.2	72.4±13.2	>0.05
Wrist extension	59.5±9.4	60.5±14.2	>0.05
VAS score	5.7±1.3	0.9±1.0	<0.05
Modified Mayo wrist score	64.8±9.2	88.6±7.6	<0.05
DASH score	24.0±9.9	7.3±5.4	<0.05

VAS, visual analogue scale; DASH, Disabilities of the Arm, Shoulder, and Hand.

Table 2.

Radiological results

Radiological measurements	Preoperative	Postoperative (last follow-up)	p-value
Scapholunate angle	70.6±10.6	52.4±4.0	<0.05
Intrascaphoid angle	51.5±6.9	33.9±3.0	<0.05

Table 3.

Factors affecting scaphoid nonunion

Characteristic	Union	Nonunion	p-value
Sex (male/female)	36/3	5/2	>0.05
Age (yr)	28.3±11.4	34.0±9.4	>0.05
Smoking (%)	42.8	71.4	<0.05
Scapholunate angle (preoperative)	68.5±10.1	62.4±7.3	>0.05
Intracscaphoid angle (preoperative)	51.6±7.0	49.7±5.0	>0.05

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