Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilatera
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ORIGINAL PAPER
Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius Wei Hsiung 1,2 & Hui-Kuang Huang 1,2,3,4 & Jung-Pan Wang 1,2 & Ming-Chau Chang 1,2 & Yi-Chao Huang 1,2 Received: 20 July 2020 / Accepted: 29 September 2020 # SICOT aisbl 2020
Abstract Purpose The treatment of delayed union and established nonunion of the scaphoid using a volar approach with impaction of bone graft, either a cancellous or cortico-cancellous wedge graft, for osteosynthesis and maintenance of reduction. With the advancement of instruments and techniques of wrist arthroscopy, wider indications for wrist problems can be solved by this minimally invasive technique. We report our results of arthroscopic reduction, cancellous bone grafting to the regional distal radius, and headless screw fixation for the treatment of scaphoid nonunion, even with humpback deformity. Methods Between August 2014 and February 2018, 41 patients (42 wrists) with unstable scaphoid nonunion received arthroscopic surgery. The mean follow-up was 38.1 months (range 24–70 months). We evaluated the results with a function questionnaire and clinical outcomes based on the visual analog scale (VAS) pain score, range of motion and grip strength, and radiologic measurements. Results The union rate was 92.6% (38/41 patients) and union time was 4.6 months. Patients regained almost a full range of motion compared with the contralateral wrist. The post-op Quick DASH, Mayo wrist score, and VAS pain score all had significant improvement, with p < 0.05. The scapholunate angle showed significant correction from pre-op 68.0° to post-op 58.3°. The average VAS satisfaction score at final follow-up was 8.7. Conclusion Arthroscopic realignment and osteosynthesis for the treatment of unstable scaphoid nonunion with ipsilateral radius bone graft, even with humpback deformity, can achieve a high union rate, good radiological correction, and good functional recovery. Keywords Scaphoid . Nonunion . Unstable . Arthroscopic . Cancellous * Yi-Chao Huang [email protected] Wei Hsiung [email protected]
Introduction
Hui-Kuang Huang [email protected]
The scaphoid fracture is most commonly caused by a fall on an outstretched hand. The fracture accounts for approximately 60% to 80% of carpal fractures. [1, 2] However, the fracture may be misdiagnosed in the early stages due to anatomical properties including poor blood supply, joint fluid dilution, and biomechanical properties such as high shear stress and displacement of fragments. Consequently, complications may include delayed union, nonunion or malunion of the fracture, avascular necrosis, and even wrist arthrosis. [3] To minimize the incidence of arthritis of the wrist, most scaphoid nonunions are managed by surgery. [4] Since the arthroscopy technique for scaphoid nonunion was described by Slade et al. in 2003, many studies have shown that arthroscopic-assisted bone grafting and percutaneous fixation for scaphoid nonunion can achieve reliable clinical o
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