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Abstract
Purpose:
The authors performed an autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment.
Methods:
We retrospectively reviewed medical records and radiographs of 30 patients who underwent a cancellous bone graft and headless compression screw fixation for scaphoid waist nonunion. There 28 men and 2 women with a mean age of 32.8 year-old (range, 21-63 year-old). The mean time to surgery from initial injury was 10 months (range, 3-25 months) and the average follow-up duration was 37.5 months (range, 15-52 months). The authors analyzed bony union, lateral intrascaphoid angle (LISA), scapholunate angle (SLA), radiolunate angle (RLA), and scaphoid length in radiographs and evaluated the modified Mayo wrist score (MMWS) as a functional outcome.
Results:
Bony union was achieved in all cases. In lateral plain X-ray, preoperative anatomic alignment including LISA, SLA, RLA, and scaphoid length was recovered at immediate postoperative measurement. Those alignment restoration was likely to maintain in final follow-up in despite of statistical difference. The wrist motion and the MMWS improved significantly at the last follow-up.
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Fig. 1.
Surgical procedures. (A) Sclerotic border of the nonunion site is removed by a burr and curette. (B) Preparation of biconcave cavity with healthy cancellous wall. (C) Packing of cancellous bone around the guide pin for the headless compression screw. (D) Headless compression screw fixation. (E) Additional tight cancellous bone packing into the surrounding defect.
Fig. 2.
Results of radiologic measurements at preoperative (Pre), immediate postoperative (Post) and final follow-up (Final). Repeated measurement analysis of variance, significance with less than p=0.05. (A) Lateral intrascaphoid angle, LISA (standard deviation) (B) Scapholunate angle, SLA (standard deviation). (C) Radiolunate angel, RLA (standard deviation). (D) Scaphoid length (standard deviation).
Fig. 3.
Radiographs in a 63-year-old male patient at injury and 1 year after surgery. (A, B) Preoperative radiographs showing the measurement of the scaphoid length and LISA. (C, D) Postoperative radiographs showing the measurement of the scaphoid length and LISA after the surgery, when the bony union is achieved. The length is improved from 2.5 cm to 2.8 cm and the LISA is decreased from 44° to 37°. LISA, lateral intrascaphoid angle.
Table 1.
Mean values for the functional measurements at the preoperative and postoperative conditions
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