J Korean Fract Soc.  2010 Jan;23(1):69-75. 10.12671/jkfs.2010.23.1.69.

Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

• Moon ES
• Kim MS
• Kong IK
• Choi MS

• KMID: 1461575
• DOI: http://doi.org/10.12671/jkfs.2010.23.1.69

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.

Keyword

Scaphoid nonunion; Internal fixation; Bone graft

MeSH Terms

Follow-Up Studies
Humans
Osteoarthritis
Transplants

Figure

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  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).

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  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.

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  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.

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  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.

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