A comparison of the rates of union after cancellous iliac crest bone graft and Kirschner-wire fixation in the treatment of stable and unstable scaphoid nonunion

Abstract

This study was performed to determine whether pure cancellous bone graft and Kirschner (K-) wire fixation were sufficient to achieve bony union and restore alignment in scaphoid nonunion. A total of 65 patients who underwent cancellous bone graft and K-wire fixation were included in this study. The series included 61 men and four women with a mean age of 34 years (15 to 72) and mean delay to surgery of 28.7 months (3 to 240). The patients were divided into an unstable group (A) and stable group (B) depending on the pre-operative radiographs. Unstable nonunion was defined as a lateral intrascaphoid angle > 45°, or a radiolunate angle > 10°. There were 34 cases in group A and 31 cases in group B. Bony union was achieved in 30 patients (88.2%) in group A, and in 26 (83.9%) in group B (p = 0.439). Comparison of the post-operative radiographs between the two groups showed no significant differences in lateral intrascaphoid angle (p = 0.657) and scaphoid length (p = 0.670) and height (p = 0.193). The radiolunate angle was significantly different (p = 0.020) but the mean value in both groups was < 10°. Comparison of the dorsiflexion and palmar flexion of movement of the wrist and the mean Mayo wrist score at the final clinical visit in each group showed no significant difference (p = 0.190, p = 0.587 and p = 0.265, respectively). Cancellous bone graft and K-wire fixation were effective in the treatment of stable and unstable scaphoid nonunion.

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

“…This small improvement might be clinically irrelevant despite statistical significance and might be because our patients maintained good preoperative wrist movement. We expected that arthroscopic management could achieve better wrist movement for patients with scaphoid nonunion than conventional open surgery; however, the flexion-extension angle measured at the last followup was similar to other studies (98°-116°) [25,26,36]. As pain, grip strength, and wrist movement improved, all of our patients who achieved bony union showed functional improvement assessed by MWS and DASH score like other studies [3,25].…”

Editorial Commentary: The Practical Goal of Arthroscopic Osteosynthesis for the Treatment of Unstable Scaphoid Nonunion

“…Considering the fact that the union rate of conventional nonvascularized bone grafts has been reported to range from 61% to 94%, [8][9][10][11][12][13] the 96.4% union rate with the arthroscopic technique in their study shows that arthroscopy has great potential to achieve a high rate of scaphoid healing. In my view, complete debridement of the devitalized tissue and bony sclerosis until healthyappearing cancellous bone is seen, using a healthy autologous cancellous bone graft, and rigid fixation using 1 or 2 headless compression screws might have been the keys to obtaining a superior rate of bony union in their study.…”

Manejo Artroscópico de Pseudoartrosis de Escafoides con Deformidad en Joroba: Técnica Quirúrgica y Serie de Casos

“…En la actualidad, existen estudios que avalan la utilización de injerto esponjoso en no-uniones inestables, con deformidad en joroba, con buenos resultados. 10,18 Sayegh y col., 15 en su revisión sistemática, concluyen que no hay deferencias con respecto a la consolidación final en pacientes operados con injerto esponjoso e injerto estructural.…”