Arch Hand Microsurg.  2019 Mar;24(1):40-49. 10.12790/ahm.2019.24.1.40.

Dorsal Approach for Management of Scaphoid Nonunion

Affiliations
  • 1Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. sw.song@catholic.ac.kr
  • 2Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 3Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

PURPOSE
To evaluate the clinical and radiological outcomes of scaphoid nonunion patients who had treated by open reduction and internal fixation with iliac bone graft through dorsal approach.
METHODS
We retrospectively reviewed medical records and radiographs of 53 patients who underwent an iliac crest bone graft and internal fixation through dorsal approach for scaphoid nonunion between 2003 and 2017. Bony union was confirmed in radiographs, and scapholunate, radiolunate, posteroanterior, intrascaphoid, and lateral intrascaphoid angles were measured on preoperative and last follow-up radiographs. Functional results were evaluated by range of motion, visual analogue scale, and modified Mayo wrist score.
RESULTS
There were 51 men and 2 women with average age of 31.2 years (range, 13-61 years). The mean time from initial injury to surgery was 16.8 months (range, 3-50 months) and mean follow-up period after the operation was 26.2 months (range, 12-76 months). Fifty of 53 patients (94.3%) showed radiographic union at an average time of 15.1 weeks (range, 8-50 weeks). The mean scapholunate angle was significantly changed from 69.3° preoperatively to 54.0° at last follow-up. The mean radiolunate angle was significantly changed from 14.3° preoperatively to 7.2° at last follow-up. The mean posteroanterior intrascaphoid angle was significantly changed from 33.2° preoperatively to 30.2° at last follow-up. The mean lateral intrascaphoid angle was significantly changed from 42.9° preoperatively to 28.8° at last follow-up.
CONCLUSION
Dorsal approach with iliac bone graft and internal fixation was a reliable method for scaphoid nonunion to achieve bony union with satisfactory clinical and radiological outcomes.

Keyword

Scaphoid; Nonunion; Dorsal approach; Iliac bone graft

MeSH Terms

Female
Follow-Up Studies
Humans
Male
Medical Records
Methods
Range of Motion, Articular
Retrospective Studies
Transplants
Wrist

Figure

  • Fig. 1 Surgical approach. (A) Skin incision line of dorsal approach for the exposure of nonunion site of scaphoid. (B) A 3rd and 4th extensor compartment covered by extensor retinaculum was exposed. (C) Interligamentous sparing approach involving the dorsal intercarpal ligament and the dorsal radiocarpal ligament. (D) Interligamentous sparing capsulotomy was used to expose nonunion site.

  • Fig. 2 Surgical procedures. (A) The distal radius and the scaphoid was exposed through an interligamentous sparing approach. The K-wire was inserted into the proximal and distal fragments of scaphoid, and the deformity was corrected by a joystick manipulation. Sclerotic border of the nonunion site was removed by a burr. (B) The cancellous bone was packed tightly at nonunion site, and the cortical bone defect was covered with a cover made of the cortical bone. And then headless compression screw was fixed. S: scaphoid, C: capitate, R: radius, Sb: scaphoid bone graft.

  • Fig. 3 Representative case of a scaphoid nonunion in 31-year-old patient. (A) Preoperative radiographs show a nonunion of the waist of the scaphoid and humpback deformity. Scapholunate angle is 56°. (B) Preoperative computed tomography scans show a nonunion of the waist of the scaphoid with humpback deformity and bony cyst. Intrascaphoid angle is 67°. (C) Radiographs at 18 months after surgery show complete bone union and no deformity. Scapholunate angle is 51°.


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