Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2010 Jan;23(1):69-75. Korean.
    Published online Jul 15, 2010.
    https://doi.org/10.12671/jkfs.2010.23.1.69
    Copyright © 2010 The Korean Fracture Society
    Original Article

    Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

    Eun Sun Moon, M.D., Myung Sun Kim, M.D., Il Kyu Kong, M.D., and Min Sun Choi, M.D.
      • Department of Orthopedic Surgery, Chonnam National University School of Medicine, Gwangju, Korea.
    • Address reprint requests to: Il Kyu Kong, M.D. Department of Orthopedic Surgery, Chonnam National University School of Medicine, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-227-1640, Fax: 82-62-225-7794, Email: kongilkyu@gmail.com
    Received July 22, 2009; Revised September 30, 2009; Accepted December 06, 2009.

    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

    To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors.

    Materials and Methods

    Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated.

    Results

    Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery.

    Conclusion

    Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.

    Keywords
    Scaphoid nonunion; Internal fixation; Bone graft

    Figures

    Fig. 1
    Fragment ratio. Horizontal lines were drawn to define the extent of the fragment. The middle of the fragment was identified and a midline was drawn connecting the two horizontal lines. The lengths of these lines (P, D) were measured to determine the fragment size (P: Proximal fragment, D: Distal fragment).

    Fig. 2
    (A) Radiographs of 22 years old male shows slightly proximally located nonunion of scaphoid.

    (B) Serial follow-up radiographs and (C) computer tomography at postoperative 8 month show failure of healing process.

    Fig. 3
    (A) Radiographs of 47 years old male shows proximally located nonunion of scaphoid.

    (B) Computer tomography demonstrates cystic change of nonunion site and degenerative change of radial styloid and radioscaphoid joint.

    (C) Serial follow-up radiographs show failure of healing process at 4 months postoperatively.

    Fig. 4
    (A) Radiographs of 16 years old female shows suspicious finding of distally located nonunion of scaphoid.

    (B) Computer tomography demonstrates cystic change of nonunion site.

    (C) Serial follow-up radiographs show complete union at about 12 weeks after surgery.

    Tables

    Table 1
    Summary of cases

    References

      1. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989;14:679–687.
      1. Amadio PC, Moran SL. Fractures of the carpal bone. In: Green DP, editor. Operative hand surgery. 5th ed. Philadelphia: Churchill Livingstone; 2005. pp. 711-779.
      1. Amadio PC, Taleisnik J. Fractures of the carpal bone. In: Green DP, editor. Operative hand surgery. 3rd ed. New York: Churchill Livingstone; 1993. pp. 799-860.
      1. Chloros GD, Themistocleous GS, Wiesler ER, Benetos IS, Efstathopoulos DG, Soucacos PN. Pediatric scaphoid nonunion. J Hand Surg Am 2007;32:172–176.
      1. Cosio MQ, Camp RA. Percutaneous pinning of symptomatic scaphoid nonunions. J Hand Surg Am 1986;11:350–355.
      1. Dias JJ. Definition of union after acute fracture and surgery for fracture nonunion of the scaphoid. J Hand Surg Br 2001;26:321–325.
      1. Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res 2006;445:108–119.
      1. Ikeda K, Osamura N, Tomita K. Percutaneous screw fixation without bone graft for cystic-type scaphoid fractures. J Trauma 2008;65:1453–1458.
      1. Jeon IH, Kochhar H, Lee BW, Kim SY, Kim PT. Percutaneous screw fixation for scaphoid nonunion in skeletally immature patients: a report of two cases. J Hand Surg Am 2008;33:656–659.
      1. Kim JK, Kim JO, Lee SY, Do NH. Volar percutaneous cannulated screw fixation for subacute scaphoid wasit fracture. J Korean Fract Soc 2009;22:104–109.
      1. Merrell G, Slade J. Technique for percutaneous fixation of displaced and nondisplaced acute scaphoid fractures and select nonunions. J Hand Surg Am 2008;33:966–973.
      1. Merrell GA, Wolfe SW, Slade JF 3rd. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am 2002;27:685–691.
      1. Ramamurthy C, Cutler L, Nuttall D, Simison AJ, Trail IA, Stanley JK. The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid. J Bone Joint Surg Br 2007;89:627–632.
      1. Schneider LH, Aulicino P. Nonunion of the carpal scaphoid: the Russe procedure. J Trauma 1982;22:315–319.
      1. 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.
      1. Shah J, Jones WA. Factors affecting the outcome in 50 cases of scaphoid nonunion treated with Herbert screw fixation. J Hand Surg Br 1998;23:680–685.
      1. Shim JI, Kim TS, Lee SJ, Lee SH, Yoo CM, Han KJ. Surgical treatment of scaphoid nonunion. J Korean Soc Fract 1996;9:15–23.
      1. 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.
    MeSH Terms
    Follow-Up Studies
    Humans
    Osteoarthritis
    Transplants
    Metrics
    Share
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    Tables
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