Download PDF
J Wrist Surg 2018; 07(02): 094-100
DOI: 10.1055/s-0038-1637739
Special Review: Scaphoid Nonunion Treatment
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Management of Scaphoid Nonunion Based on the Biomechanical Study

Kunihiro Oka
1   Health and Counseling Center, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
,
Hisao Moritomo
2   Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka, Japan
› Author Affiliations Funding The authors were supported by JSPS KAKENHI (grant number JP 15K10442).
Further Information

Publication History

21 December 2017

08 February 2018

Publication Date:
14 March 2018 (online)

   Permissions and Reprints

Abstract

Scaphoid nonunion causes abnormal wrist kinematics and typically leads to carpal collapse and subsequent degenerative arthritis of the wrist. However, the natural history, including carpal collapse and degenerative arthritis of scaphoid nonunion, may vary at different fracture locations. This article reviews recent biomechanical studies related to the natural history of scaphoid nonunion. In the distal-type fractures (type B2 in Herbert classification), where the fracture located distal to the scaphoid apex, the proximal scaphoid fragment and lunate, which are connected through the dorsal scapholunate interosseous ligament (DSLIL) and dorsal intercarpal ligament (DIC), extend together, and the distal fragment of the scaphoid flexes individually. Therefore, untreated type B2 fractures normally show the humpback deformity, resulting in dorsal intercalated segment instability deformity relatively earlier after the injury. In the proximal-type fractures (type B1), where the fracture is located proximal to the scaphoid apex, the connection between the distal fragment and lunate is preserved through the DSLIL and DIC so that the scaphoid–lunate complex remains stable and the carpal collapse is less severe than that in distal-type fractures. The fracture location relative to the apex of the dorsal scaphoid ridge is a reliable landmark in the determination of the natural history of scaphoid nonunion.

Keywords

scaphoid nonunion - natural history - carpal collapse - three-dimensional analysis
 

  • References

  • 1 Brogan DM, Moran SL, Shin AY. Outcomes of open reduction and internal fixation of acute proximal pole scaphoid fractures. Hand (NY) 2015; 10 (02) 227-232
    CrossrefPubMedGoogle Scholar
  • 2 Leslie IJ, Dickson RA. The fractured carpal scaphoid. Natural history and factors influencing outcome. J Bone Joint Surg Br 1981; 63-B (02) 225-230
    CrossrefPubMedGoogle Scholar
  • 3 Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J 2016; 98-B (05) 654-659
    CrossrefPubMedGoogle Scholar
  • 4 Dias JJ, Brenkel IJ, Finlay DB. Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br 1989; 71 (02) 307-310
    CrossrefPubMedGoogle Scholar
  • 5 Mack GR, Bosse MJ, Gelberman RH, Yu E. The natural history of scaphoid non-union. J Bone Joint Surg Am 1984; 66 (04) 504-509
    CrossrefPubMedGoogle Scholar
  • 6 Oka K, Murase T, Moritomo H, Goto A, Sugamoto K, Yoshikawa H. Patterns of bone defect in scaphoid nonunion: a 3-dimensional and quantitative analysis. J Hand Surg Am 2005; 30 (02) 359-365
    CrossrefPubMedGoogle Scholar
  • 7 Gehrmann S, Roeger T, Kaufmann R, Schaedle A, Lögters T, Windolf J. Wrist motion analysis in scaphoid nonunion. Eur J Trauma Emerg Surg 2016; 42 (01) 11-14
    CrossrefPubMedGoogle Scholar
  • 8 Moritomo H, Murase T, Oka K, Tanaka H, Yoshikawa H, Sugamoto K. Relationship between the fracture location and the kinematic pattern in scaphoid nonunion. J Hand Surg Am 2008; 33 (09) 1459-1468
    CrossrefPubMedGoogle Scholar
  • 9 Moritomo H, Tada K, Yoshida T, Masatomi T. The relationship between the site of nonunion of the scaphoid and scaphoid nonunion advanced collapse (SNAC). J Bone Joint Surg Br 1999; 81 (05) 871-876
    CrossrefPubMedGoogle Scholar
  • 10 Moritomo H, Viegas SF, Elder KW. , et al. Scaphoid nonunions: a 3-dimensional analysis of patterns of deformity. J Hand Surg Am 2000; 25 (03) 520-528
    CrossrefPubMedGoogle Scholar
  • 11 Oka K, Moritomo H, Murase T, Goto A, Sugamoto K, Yoshikawa H. Patterns of carpal deformity in scaphoid nonunion: a 3-dimensional and quantitative analysis. J Hand Surg Am 2005; 30 (06) 1136-1144
    CrossrefPubMedGoogle Scholar
  • 12 Oura K, Moritomo H, Kataoka T. , et al. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion. J Orthop Sci 2017; 22 (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 13 Schweizer A, Fürnstahl P, Nagy L. Three-dimensional computed tomographic analysis of 11 scaphoid waist nonunions. J Hand Surg Am 2012; 37 (06) 1151-1158
    CrossrefPubMedGoogle Scholar
  • 14 Werner FW, St-Amand H, Moritomo H, Sutton LG, Short WH. The effect of scaphoid fracture site on scaphoid instability patterns. J Wrist Surg 2016; 5 (01) 47-51
    PubMedGoogle Scholar
  • 15 Nakamura R, Imaeda T, Horii E, Miura T, Hayakawa N. Analysis of scaphoid fracture displacement by three-dimensional computed tomography. J Hand Surg Am 1991; 16 (03) 485-492
    CrossrefPubMedGoogle Scholar
  • 16 Moritomo H. Radiographic clues for determining carpal instability and treatment protocol for scaphoid fractures. J Orthop Sci 2014; 19 (03) 379-383
    CrossrefPubMedGoogle Scholar
  • 17 Garcia-Elias M. Kinetic analysis of carpal stability during grip. Hand Clin 1997; 13 (01) 151-158
    CrossrefPubMedGoogle Scholar
  • 18 Kauer JM. Functional anatomy of the wrist. Clin Orthop Relat Res 1980; (149) 9-20
    PubMedGoogle Scholar
  • 19 Smith DK, Cooney III WP, An KN, Linscheid RL, Chao EY. The effects of simulated unstable scaphoid fractures on carpal motion. J Hand Surg Am 1989; 14 (2 Pt 1): 283-291
    PubMedGoogle Scholar
  • 20 Weber ER. Biomechanical implications of scaphoid waist fractures. Clin Orthop Relat Res 1980; (149) 83-89
    PubMedGoogle Scholar
  • 21 Garcia-Elias M, Lluch A. Partial excision of scaphoid: is it ever indicated?. Hand Clin 2001; 17 (04) 687-695
    PubMedGoogle Scholar
  • 22 Hidaka Y, Nakamura R. Progressive patterns of degenerative arthritis in scaphoid nonunion demonstrated by three-dimensional computed tomography. J Hand Surg Br 1998; 23 (06) 765-770
    CrossrefPubMedGoogle Scholar
  • 23 Inoue G, Sakuma M. The natural history of scaphoid non-union. Radiographical and clinical analysis in 102 cases. Arch Orthop Trauma Surg 1996; 115 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 24 Kozin SH. Incidence, mechanism, and natural history of scaphoid fractures. Hand Clin 2001; 17 (04) 515-524
    PubMedGoogle Scholar
  • 25 Ruby LK, Stinson J, Belsky MR. The natural history of scaphoid non-union. A review of fifty-five cases. J Bone Joint Surg Am 1985; 67 (03) 428-432
    CrossrefPubMedGoogle Scholar
  • 26 Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am 1987; 12 (04) 514-519
    CrossrefPubMedGoogle Scholar
  • 27 Lee DJ, Elfar JC. Carpal ligament injuries, pathomechanics, and classification. Hand Clin 2015; 31 (03) 389-398
    CrossrefPubMedGoogle Scholar
  • 28 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
    CrossrefPubMedGoogle Scholar
  • 29 Leventhal EL, Wolfe SW, Moore DC, Akelman E, Weiss AP, Crisco JJ. Interfragmentary motion in patients with scaphoid nonunion. J Hand Surg Am 2008; 33 (07) 1108-1115
    CrossrefPubMedGoogle Scholar
  • 30 Inagaki H, Nakamura R, Horii E, Nakao E, Tatebe M. Differences in radiographic findings between scaphoid fracture patterns. Hand Surg 2004; 9 (02) 197-202
    CrossrefPubMedGoogle Scholar