Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions

doi:10.1016/S0363-5023(09)91122-4

The Journal of Hand Surgery

Volume 15, Issue 1, January 1990, Pages 140-147

https://doi.org/10.1016/S0363-5023(09)91122-4 Get rights and content

The results of 20 established nonunions of the scaphoid treated with resection of the pseudoarthrosis, anterior cortico-cancellous iliac bone grafting, and conventional lag screw fixation with the ASIF 2.7 mm cortical screw are presented. Union rate was 95% and the average time off work was 8.9 weeks. Review of the relevant literature uniformly shoves that the most common reasons for failure are improper internal fixation techniques and/or the absence of bone grafting. Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.

References (22)

J Taleisnik
WP Cooney et al.
Scaphoid non-union: role of anterior interpositional bone grafts
J Hand Surg
(1988)
U Heim et al.U Heim et al.U Heim et al.
RH Maudsley et al.
Screw fixation in the management of the fractured carpal scaphoid
J Bone Joint Surg
(1972)
O Russe
Die Kahnbeinpseudarthrose, Behandlung und Ergebnisse
Unfallheilkunde
(1980)
GR Fisk
Operative surgery. Part II
RL Linscheid et al.
Volar wedge grafting of the carpal scaphoid in non-union associated with dorsal instability patterns
RL Linscheid et al.
Volar wedge grafting of the carpal scaphoid in non-union associated with dorsal instability patterns
J Bone Joint Surg
(1982)
DL Fernandez
A technique for anterior wedge-shaped grafts for scaphoid non-unions with carpal instability
J Hand Surg
(1984)
GR Mack et al.
Scaphoid nonunion
R Nakamura et al.
Reduction of the scaphoid fracture with DISI alignment
J Hand Surg
(1987)

G Segmüller

Cited by (119)

Structural Versus Nonstructural Bone Grafting for the Treatment of Unstable Scaphoid Waist Nonunion Without Avascular Necrosis: A Randomized Clinical Trial
2021, Journal of Hand Surgery
We evaluated the impact of structural versus nonstructural bone grafting on the time to union, scaphoid deformity correction, and clinical outcomes in adults with unstable scaphoid waist nonunion without avascular necrosis. We hypothesized that nonstructural grafting would provide earlier time to union, restoration of scaphoid anatomy, and equivalent clinical outcomes compared with structural grafting.
We prospectively randomized 98 patients to undergo open reduction, iliac crest bone grafting with either corticocancellous (CC group) or cancellous bone only (C-only), and internal fixation using a Herbert screw. The lateral intrascaphoid angle (LISA) and scaphoid height length ratio (HLR) were measured on wrist computed tomography scans along the scaphoid longitudinal axis before surgery and an average of 84 weeks afterward. Pain, range of motion, grip strength, and Quick–Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score were measured before surgery and an average 84 weeks afterward.
The trajectory of scaphoid union showed a higher union rate of the C-only group at 12, 14, and 16 weeks after surgery. However, at 24 weeks after surgery, there was no difference between the groups, The union rate was 94% in patients treated with C-only and 90% with CC grafting. In patients with preoperative LISA less than 70° and/or HLR less than 0.80 (n = 53), there were no differences between the CC and C-only grafting techniques for radiographic and clinical outcomes, QuickDASH scores, and malunion rate. In patients who had preoperative LISA greater than 70° and/or HLR greater than 0.80 (n = 45), radiographic outcome measures, range of motion, and QuickDASH scores were significantly better in the CC than in the C-only group. Scaphoid malunion was observed in 9 of 22 of C-only patients (41%) and 4 of 23 of CC patients (18%).
The severity of the scaphoid deformity may be a factor in determining the best graft type, because this may affect the rate of successful deformity correction. Corticocancellous grafting in patients who had a high degree of scaphoid deformity provided consistent deformity correction and superior QuickDASH scores. Otherwise, C-only grafting provides earlier time to union and equivalent clinical and radiographic outcomes compared with CC grafting.
Therapeutic I.
Comparative outcome analysis of internal screw fixation and Kirschner wire fixation in the treatment of scaphoid nonunion
2020, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Informed consent was obtained from all patients. The operative approach was performed in a standardized manner as described earlier.7,8 During follow-up, the MAYO wrist score was applied, including pain intensity, functional status, range of motion, and grip strength with patients answering multiple-choice questions covering previous four weeks.
In cases with difficult scaphoid screw placement due to small, fragile bone fragments, or transplants and insufficient space, the internal Kirschner wire fixation is a fallback option; however, controversy remains regarding its stability, safety, and outcome. Between 2001 and 2011, 95 patients were treated in our center (n = 80 with cannulated compression screws and n = 15 with Kirschner wires), and retrospectively analyzed. The outcome measurements included the analysis of patient data, union rate and analysis of functional measures, and quality of life. Bony reconstructions were performed with Vascularized Bone Grafts (VBG) based on the 1,2-Intercompartmental Supraretinacular Artery (ICSRA) , Medial Femoral Condyle (MFC)-VBG, cancellous bone, and iliac crest grafts. Bony healing and functional outcome showed no significant differences between Kirschner wire fixation and cannulated compression screws, although significantly more 1,2-ICSRA-VBG were treated with Kirschner wires. Although predominantly used as an intraoperative fallback option, our data demonstrate that Kirschner wire internal fixation can be safe and reliable, with comparable bony union rates and excellent functional outcomes.
The Author's Technique for the Management of Unstable Scaphoid Nonunions: Tips and Tricks
2019, Hand Clinics
The Role of Vascularized Bone Grafting in Scaphoid Nonunion
2019, Hand Clinics
Does Anyone Need a Vascularized Graft?
2019, Hand Clinics
Corticocancellous bone graft vs cancellous bone graft for the management of unstable scaphoid nonunion
2018, Orthopaedics and Traumatology: Surgery and Research
This study was undertaken to determine whether corticocancellous bone grafting and cancellous bone grafting differ in terms of bone union rate, restoration of scaphoid anatomy, and wrist function when unstable scaphoid nonunions are concomitantly treated by screw fixation.
This is retrospective cohort study. In Group A (17 patients), unstable scaphoid nonunion was treated with corticocancellous graft harvested from the iliac crest and headless compression screw using volar approach. In Group B (18 patients), unstable scaphoid nonunion was treated with cancellous graft harvested from the distal radius or iliac crest and headless compression screw using volar approach Mean time to union was measured using CT image. Scaphoid deformity was also measured using lateral intrascaphoid angle and height to length ratio using CT images. Wrist functional status was assessed by measuring grip strength, wrist range of motion, and DASH score at 1 year postoperatively.
Mean time to union was significantly greater in Group A (15 weeks vs. 11 weeks). No significant intergroup difference was observed for lateral intrascaphoid angle and height to length ratio after treatment of scaphoid nonunion. No significant intergroup difference was observed for grip strength, wrist range of motion, or DASH scores at 1 year postoperatively.
Cancellous bone grafting was found to lead to earlier bone union than corticocancellous bone grafting and to similar restorations of scaphoid deformity and wrist function when scaphoid nonunion was treated by headless compression screw fixation and bone grafting.
Prognostic, III.

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¹: From the Department of Surgery, Kantonsspital Aarau, Aarau, Switzerland.

View full text

Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions

J Hand Surg

J Bone Joint Surg

Die Kahnbeinpseudarthrose, Behandlung und Ergebnisse

Unfallheilkunde

Operative surgery. Part II

Volar wedge grafting of the carpal scaphoid in non-union associated with dorsal instability patterns

Volar wedge grafting of the carpal scaphoid in non-union associated with dorsal instability patterns

J Bone Joint Surg

A technique for anterior wedge-shaped grafts for scaphoid non-unions with carpal instability

J Hand Surg

Scaphoid nonunion

Reduction of the scaphoid fracture with DISI alignment

J Hand Surg