Arch Hand Microsurg.  2018 Mar;23(1):35-45. 10.12790/ahm.2018.23.1.35.

Operative Treatment for Nonunion of the Distal Scaphoid

• Lee SY
• Shin J
• Oh WT
• Choi YR
• Koh IH
• Kang HJ

• KMID: 2412489
• DOI: http://doi.org/10.12790/ahm.2018.23.1.35

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.

Keyword

Scaphoid nonunion; Distal pole; Osteosynthesis

MeSH Terms

Arm
Follow-Up Studies
Hand
Hand Strength
Humans
Incidence
Joints
Postoperative Complications
Range of Motion, Articular
Reference Values
Shoulder
Transplants
Wrist
Wrist Joint

Figure

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  Fig. 1 Watershed zone: distal third. Data from the article of Gelberman et al.7 (J Hand Surg Am. 1980;5:508-13).

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  Fig. 2 Intraoperative bone defect measuring and osteosynthesis with auto-iliac corticocancellous block bone graft.

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  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.

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  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.

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  Fig. 5 3D printer program image: preliminary reconstruction of scaphoid nonunion.

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