Operative Treatment for Nonunion of the Distal Scaphoid

Sang-yun Lee; Jucheol Shin; Won-taek Oh; Yun-Rak Choi; Il-Hyun Koh; Ho-Jung Kang

doi:10.12790/ahm.2018.23.1.35

Journal List > Arch Hand Microsurg > v.23(1) > 1106629

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Lee, Shin, Oh, Choi, Koh, and Kang: Operative Treatment for Nonunion of the Distal Scaphoid

Hand

Archives of Hand and Microsurgery 2018; 23(1): 35-45.

Published online: 2 March 2018

DOI: https://doi.org/10.12790/ahm.2018.23.1.35

Operative Treatment for Nonunion of the Distal Scaphoid

Sang-yun Lee, Jucheol Shin, Won-taek Oh, Yun-Rak Choi, Il-Hyun Koh, Ho-Jung Kang

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Ho-Jung Kang. Department of Orthopaedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. TEL: +82-2-2019-3412, FAX: +82-2-573-5393, KANGHO56@yuhs.ac

Received 15 December 2017 Revised 25 January 2018 Accepted 31 January 2018

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(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/4.0/) 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 and radiological outcomes of distal scaphoid nonunion patients who underwent operative treatment.

Methods

From July 2006 to May 2014, there were a total of 9 distal scaphoid nonunion patients, with a mean age of 32 years. The mean time from symptom onset to operation was 15 months. Operative treatment was performed through a volar approach, osteosynthesis with an auto-iliac bone graft was performed. Union was determined through radiographs and computed tomography, while the scapholunate angle (SLA) and lateral intrascaphoid angle (LISA) were measured. Clinical outcomes were evaluated by assessing range of motion (ROM) of the wrist, the visual analogue scale (VAS), Mayo wrist score, and disabilities of arm, shoulder and hand (DASH) score.

Results

The incidence of distal scaphoid nonunion was 11.8% (9/76), with all patients demonstrating union after the operation. Mean union time was 5 months and mean follow-up period was 23 months. Both SLA and LISA decreased, returning to normal range. The ROM of the wrist joint increased but not statistically significant. The postoperative VAS pain score improved, while grip strength advanced. In addition, both postoperative Mayo wrist and DASH scores document better results than those of pre-operation. Overall, there were two postoperative complication cases of joint motion limitation and pin site irritation.

Conclusion

Osteosynthesis with auto-iliac bone graft for nonunion of the distal scaphoid showed good clinical and radiological outcomes. Thus, it is considered a recommendable operation in the treatment of distal scaphoid nonunion.

Keywords: Scaphoid nonunion, Distal pole, Osteosynthesis

Figures and Tables

Fig. 1

Watershed zone: distal third. Data from the article of Gelberman et al.7 (J Hand Surg Am. 1980;5:508-13).

Fig. 2

Intraoperative bone defect measuring and osteosynthesis with auto-iliac corticocancellous block bone graft.

Fig. 3

A 29-year-old man who was induced osteosynthesis. (A, B) A preoperative plain radiographs showed distal scaphoid nonunion (arrows). (C-E) Preoperative computed tomography scan showed sclerosis at nonunion site and dorsal intercalated segment instability (DISI) deformity (arrowheads). (F, G) Immediate postoperative images (volar approach, 3 Headless screws, 2 temporary K-wires with auto iliac corticocancellous bone graft). (H, I) Radiograph at 1 year after the operation showed bone union. Some DISI deformity remains, but overall alignment is maintained.

Fig. 4

A 26-year-old man who was induced osteosynthesis. (A, B) A preoperative plain radiographs showed distal scaphoid nonunion (arrow). (C, D) Preoperative computed tomography scan showed sclerosis at the nonunion site, scaphoid nonunion advanced collapse and dorsal intercalated segment instability (DISI) deformity (arrowheads). (E, F) Immediate postoperative images (volar approach, Headless screw, K-wire and mini-screw fixation with auto iliac corticocancellous bone graft and radial styloidectomy). (G, H) Radiograph at 1 year after the operation showed bone union. Some DISI deformity remains, but overall alignment is maintained.

Fig. 5

3D printer program image: preliminary reconstruction of scaphoid nonunion.

Table 1

Classifications of distal scaphoid fractures of three different groups

Table 2

Summary of cases

K-wire: Kirschner's wire, CCS: cannulated cancellous screw, HCS: Headless compression screw.

Table 3

Clinical and radiologic outcomes at last follow-up

Values are presented as mean only.

VAS: visual analogue scale, MWS: Mayo wrist score, DASH: disabilities of arm, shoulder and hand, SLA: scapholunate angle, LISA: lateral intrascaphoid angle.

^*p-values are assessed by two-sample t-test, Welch two-sample test or Wilcoxon rank sum test in continuous values, and by Fisher test in categorical values. ^†Percentage compared to contra-lateral side. ^‡p<0.05.

Table 4

Postoperative complication

AVN: avascular necrosis.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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