J Korean Soc Surg Hand.  2014 Mar;19(1):19-28. 10.12790/jkssh.2014.19.1.19.

Arthroscopically assisted Cancellous Bone Grafting and Percutaneous K-Wires Fixation for the Treatment of Scaphoid Nonunions

• Lee YK
• Woo SH
• Ho PC
• Park JG
• Kim JY

• KMID: 1896923
• DOI: http://doi.org/10.12790/jkssh.2014.19.1.19

Abstract

PURPOSE
The purpose of this study was to analyze the clinical results of patients with scaphoid nonunions treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation.
METHODS
We retrospectively reviewed 20 patients with a scaphoid nonunions which was treated with arthroscopically assisted bone grafting and percutaneous K-wires fixation from November 2008 to July 2012. Time from injury to treatment was 74 months (range, 3-480 months) in average. Functional outcome was evaluated using the modified Mayo wrist score and visual analogue scale (VAS) for pain, which were measured before operation and at the last follow up.
RESULTS
All nonunions were healed successfully. The average radiologic union time was 9.7 weeks (range, 7-14 weeks). The average VAS score improved from 6.3 (range, 4-8) preoperatively to 1.6 (range, 0-3) at the last follow up. The average modified Mayo wrist score increased from 62.5 preoperatively to 85.7 at the last follow-up.
CONCLUSION
Arthroscopically assisted bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion. It may provide more biological environment than open surgery as a minimally invasive procedure.

Keyword

Scaphoid nonunion; Arthroscopy; Bone graft; K-wire

MeSH Terms

Arthroscopy
Bone Transplantation*
Follow-Up Studies
Humans
Retrospective Studies
Wrist

Figure

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  Fig. 1. A 46-year-old male patient with nonunion of the left scaphoid fracture. Preoperative left wrist plain scaphoid (A) view show nonunion at the waist of the scaphoid. (B) Same patient's left wrist, midcarpal arthroscopy image of scaphoid nonunion site shows large gap and sclerotic margins of both fragments. P, proximal fragment; D, distal fragment; MCR, midcarpal radial.

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  Fig. 2. Provisional K-wire fixation.

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  Fig. 3. (A) Left wrist, midcarpal arthroscopy image which is finished bone graft to the nonunion site percutaneously using cannula and trocar. (B, C) Same patient's left wrist, midcarpal arhroscopy images of percutaneous autogenous iliac cancellous bone grafting at the nonunion site using cannula and trocar. MCR, midcarpal radial.

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  Fig. 4. Immediate postoperative plain left wrist anteroposterior (A) and scaphoid (B) radiographs show internal fixation with K-wires and grafted bone at the nonunion site.

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  Fig. 5. Postoperative 49 months later follow-up plain left wrist scaphoid (A) and photographs (B, C) show complete bony union and excellent clinical result.

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