Scaphoid Nonunion Is a Disabling Problem in a Military Population

Abstract

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery

“…Although her corrective osteotomy was uneventful, multiple studies have shown poorer results with delayed fracture care and delayed traumatic care as well. 3 4 Additionally, delayed nerve and tendon repair, as experienced by patient 3 in this cohort, could also lead to poorer long-term outcomes. 13 14…”

“…Although her corrective osteotomy was uneventful, multiple studies have shown poorer results with delayed fracture care and delayed traumatic care as well. 3,4 Additionally, delayed nerve and tendon repair, as experienced by patient 3 in this cohort, could also lead to poorer long-term outcomes. 13,14 A paucity of data exists with regard to severity of symptoms and perioperative risk, as most studies report on a heterogeneous population, with a variety of procedures, with and without symptoms.…”

“…2 Although delaying surgery in those with an active SARS-CoV-2 infection may improve risk of pulmonary complications, delaying surgeries may conversely cause deleterious effects on functional outcome and/or extend patient morbidity. 3,4 Several studies have shown an increase in complications in those with a positive test; however, most studies report on a heterogeneous cohort examining a variety of patients with and without symptoms. 1,[5][6][7] Furthermore, an assortment of surgical specialties, patient comorbidities, and types of anesthesia reported adds difficulty in determining the true risk of an individual.…”

Clinical and Epidemiological Features of Scaphoid Fracture Nonunion: A Hospital‐Based Study in Beijing, China

“… 6 found osteoarthritis in 56% of the nonunion cases after 36 years compared with 2% of the healed fractures. More and more attention was paid to nonunion of scaphoid fracture because it could decrease the function of the wrist and greatly affect the patients' life quality 7 , 8 , 9 . The nonunion rate of scaphoid fracture in the literature was 10%–40% 10 , 11 .…”