The Result of Percutaneous Screw Fixation without Bone Grafting for Scaphoid Waist Nonunion under Local Anesthesia

Jung-Kwon Cha; Ji-Kang Park; Seung-Myoung Choi; Jae-Young Yang

doi:10.12790/jkssh.2017.22.2.89

Journal List > J Korean Soc Surg Hand > v.22(2) > 1106584

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Cha, Park, Choi, and Yang: The Result of Percutaneous Screw Fixation without Bone Grafting for Scaphoid Waist Nonunion under Local Anesthesia

Original Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(2): 89-95.

Published online: 22 June 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.2.89

The Result of Percutaneous Screw Fixation without Bone Grafting for Scaphoid Waist Nonunion under Local Anesthesia

Jung-Kwon Cha, Ji-Kang Park, Seung-Myoung Choi, Jae-Young Yang

Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.

Correspondence to: Ji-Kang Park. Department of Orthopaedic Surgery, Chungbuk National University Hospital, 776 1sunhwan-ro, Heungdeok-gu, Cheongju 28644, Korea. TEL: +82-43-269-6077, FAX: +82-43-274-8719, carm0916@hanmail.net

Received 26 December 2016 Revised 7 March 2017 Accepted 22 March 2017

(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

The purpose of this study was to analyze the results of patients with scaphoid waist nonunion treated with percutaneous screw fixation without bone grafting under local anesthesia.

Methods

We enrolled scaphoid waist nonunion of 15 patients which had no deformity, displacement, evidence of avascular necrosis and bone cyst under 5 mm on its radiological study. All patients were male with an average age of 28.9±6.2 years (range, 17–38 years). The mean time to surgery from initial injury was 10.8±2.2 months (range, 6–14 months). All patients were treated with percutaneous screw fixation without bone grafting via volar approaching under local anesthesia and postoperative radiographs were reviewed and documented the flexion and extension arcs of the injured wrist and uninjured wrist, disability of the arm, shoulder and hand (DASH) score at final follow-up.

Results

All 15 patients showed radiological union at an average 5.5±1.0 months. At 12 months follow-up, the flexion and extension arcs of the injured wrist were 95% and 98.5% of the uninjured wrist. The average DASH score at final follow-up was 7±3.9 (range, 0–15). None of these patients showed any complications associated with surgery.

Conclusion

Percutaneous screw fixation without bone grafting under local anesthesia was reliable primary treatment method for scaphoid waist non-union without displacement or deformation in the fracture site.

Keywords: Scaphoid bones, Ununited fractures, Percutaneous, Fracture fixation

Figures and Tables

Fig. 1

Preoperative X-ray shows nonunion and cystic bone lesion at the scaphoid waist in a 26-year-old man who injured 14 months ago. (A) Posteroanterior (PA) view, (B) lateral view, (C) biliard view, and (D) ulnar deviation PA view.

Fig. 2

Computed tomography (CT) shows 4 mm sized cystic bone resorption and sclerotic change without any deformity in the scaphoid nonunion site at sagittal image.

Fig. 3

Postoperative 6 months radiographs demonstrates complete bone union.

Fig. 4

Photographs shows nearly complete recovery of range of motion at the final follow-up.

Table 1

Demography of the patients

DASH, disability of the arm, shoulder and hand; ROM, range of motion.

Table 2

Classification system for scaphoid nonunion

Notes

^{CONFLICT OF INTEREST} No potential conflict of interest relevant to this article was reported.

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