Residual flexion deformity after scaphoid nonunion surgery: 7-year follow-up study

Abstract

The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5–10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height–length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity ( n = 33) and no deformity ( n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function. Level of evidence: IV

Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting

“…Surprisingly, unlike the findings of Oh et al (2018), we did not see much difference in the correction of angulation between the groups, even though 17 out of 27 patients from our OG group were treated with cancellous bone grafts taken from the iliac bone. Furthermore, their results of the HLR of 0.55 in the open group might perhaps suggest an overcorrection of the scaphoid deformity relative to the normal HLR range of 0.58 to 0.61 for the scaphoid bone (Guldbrandsen et al, 2021;Schriever and Wilcke, 2023;ten Berg et al, 2015). According to some studies that advocate a slight overcorrection of the humpback deformity to correct the Dorsal Intercalated Segment Instability (DISI) deformity, this might have a reasonable and beneficial clinical relevance (Mathoulin and Arianni, 2018).…”

“…The patients who received vascular grafting were treated due to failure of the bony union following previous surgery for the scaphoid nonunion. The patients who received structural grafts were mainly having gross humpback deformity defined as a scaphoid height-to-length ratio (HLR) of >0.80 (Schriever and Wilcke, 2023). Scaphoid nonunion was defined as a stage of unhealed scaphoid fracture after a minimum of 2 months following the injury, regardless of any conservative treatment.…”

Wrist & Hand

“…However, nonoperative management for most of these injuries in the elderly is yet to be bettered in the literature; this recent meta-analysis from Brisbane (Australia) supports this view but updates the evidence informing it. 1 The team looked at all eligible level I to III studies from 2000 to 2022 that compared surgery with nonoperative management for displaced fractures of the proximal humerus. The authors also set a minimum mean age of 50 years, a minimum follow-up of six months, and the use of at least one validated functional outcome score.…”

“…To address this question, authors from Stockholm (Sweden) retrospectively reviewed the records of 63 patients who underwent scaphoid nonunion surgery at a single regional centre. 1 The initial surgery was performed between 2007 and 2017, and, for the purposes of this study, bilateral nonunions were excluded. Nonunions were included regardless of location of fracture and all identified patients were invited by letter to participate.…”