J Korean Soc Surg Hand.  2014 Mar;19(1):36-43. 10.12790/jkssh.2014.19.1.36.

Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

• Lee JH
• Kim MS

• KMID: 1896925
• DOI: http://doi.org/10.12790/jkssh.2014.19.1.36

Abstract

PURPOSE
We evaluated clinical and radiographic results of the pure cancellous bone grafting and internal fixation for the treatment of scaphoid waist nonunions with humpback deformity.
METHODS
The subject of this study were 46 patients who had a scaphoid waist nonunion with humpback deformity treated with bone grafting between January 2005 and December 2011. The average follow-up period was 18.6 months (range, 12-26 months). We performed open reduction through an anterior approach with correction of the deformity and insertion of a screw from distal to proximal. We filled the resultant defect with pure cancellous autograft. The clinical results were evaluated with range of motion of the wrist joint, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score and visual analogue scale. For radiographic evaluation, we assessed lateral scapholunate angle and intrascaphoid angle.
RESULTS
Bony union was achieved in 39 out of 46 patients (84.8%). DASH score significantly improved from 24.0 to 7.3 postoperatively. The modified Mayo wrist score also increased from 64.8 to 88.6 postoperatively. There were 17 excellent results 18 good results. The average scapholunate angle and intrascaphoid angle improved from 70.6degrees, 51.5degrees to 52.4degrees, 33.9degrees postoperatively.
CONCLUSION
Pure cancellous bone grafting and internal fixation provide good clinical result in patients with a scaphoid waist nonunion with successful restoration of the humpback deformity.

Keyword

Scaphoid; Nonunion; Humpback deformity; Cancellous bone graft

MeSH Terms

Arm
Autografts
Bone Transplantation*
Congenital Abnormalities*
Follow-Up Studies
Hand
Humans
Range of Motion, Articular
Shoulder
Wrist
Wrist Joint

Figure

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  Fig. 1. (A) Preoperative radiographs shows nonunion of scaphoid waist. (B) Computed tomography shows scaphoid nonunion and humpback deformity.

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  Fig. 2. Intraoperatively. (A) The leading part of the pin was anchored in the center of the proximal pole with it completely across the bone graft. (B) The final axis of the pin was parallel to the volar surface of the scaphoid.

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  Fig. 3. (A) One year after surgery radiographs showed union of scaphoid waist fracture. (B) on computed tomography scan, humpback deformity was corrected.

Reference

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