J Korean Orthop Assoc.  2016 Apr;51(2):125-132. 10.4055/jkoa.2016.51.2.125.

Preservation of Scaphoid in Scaphoid Nonunion Advanced Collapse Stage II and III

• Kang HJ
• Koh IH
• Choi YR
• Kim JS
• Park YC

• KMID: 2162046
• DOI: http://doi.org/10.4055/jkoa.2016.51.2.125

Abstract

PURPOSE
The purpose of this study is to investigate the outcome of open reduction and internal fixation with a headless screw and auto iliac bone graft for patients of scaphoid nonunion advanced collapse (SNAC) stage II and III.
MATERIALS AND METHODS
A retrospective analysis was conducted for 10 patients diagnosed with stage II or III SNAC, and consequently treated with open reduction and internal fixation with a headless screw and auto iliac bone graft with or without radial styloidectomy between 2010 and 2013. Radiographic results were evaluated by bone union, the scapholunate angle and lateral intrascaphoid angle. Clinical results were evaluated by range of motion, pain, grip strength, Mayo wrist score, and assessment of Maudsley.
RESULTS
All patients showed union after the operation. Final follow-up X-rays show smoothening of the articular surface with improvement of sclerotic lesions of the articular surface, cystic lesions and osteopenic lesions. Pain decreased after the operation compared with preoperative status, grip strength and Mayo wrist score showed significant improvement. Scapholunate angle and lateral intrascaphoid angle decreased after the operation, but it was not significant. According to assessment of Maudsley, among 10 cases, there were 4 excellent cases, 4 good cases and 2 fair cases.
CONCLUSION
Restoration of stability of scaphoid is important to SNAC stage II and III, open reduction and internal fixation with a headless screw and auto iliac bone graft shows satisfactory clinical and radiologic outcomes. Thus it is considered a recommendable operation.

Keyword

scaphoid bone; scaphoid nonunion advanced collapse; scaphoid nonunion advanced collapse stage II & III; headless screw fixation and auto iliac bone graft

MeSH Terms

Follow-Up Studies
Hand Strength
Humans
Range of Motion, Articular
Retrospective Studies
Scaphoid Bone
Transplants
Wrist

Figure

• 

  Figure 1 A 55-year-old male patient. Scaphoid nonunion advanced collapse (SNAC) stage II. (A) Preoperative radiograph showed SNAC stage II. (B) Preoperative computed tomography (CT) scan showed sclerosis and cystic lesion around scaphoid. (C) Radiograph at 1 year after the operation (dorsal ante-grade 1 headless screw and miniscrew fixation with auto iliac corticocancellous bone graft and styloidectomy) showed bone union and smoothening of the articular surface. (D) CT scan at 8 months after the operation showed a decrease of sclerosis and cystic lesions.

• 

  Figure 2 A 59-year-old male patient. Scaphoid nonunion advanced collapse (SNAC) stage III. (A) Preoperative radiograph showed SNAC stage III. (B) Preoperative computed tomography (CT) scan showed multiple cystic lesion on lunate and capitate bone, and bony spur at the radial styloid process. (C) Radiograph at 1 year after the operation (dorsal ante-grade two headless screw fixation with auto iliac cancellous bone graft and styloidectomy) showed bone union. (D) CT scan at 6 months after the operation showed a significant decrease of cystic lesions, sclerosis, and bone union.

Reference

1. Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br. 1984; 66:114–123.

2. Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg. 1999; 33:423–426.

3. Leventhal EL, Wolfe SW, Moore DC, Akelman E, Weiss AP, Crisco JJ. Interfragmentary motion in patients with scaphoid nonunion. J Hand Surg Am. 2008; 33:1108–1115.

4. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984; 9:358–365.

5. Watson HK, Ryu J. Evolution of arthritis of the wrist. Clin Orthop Relat Res. 1986; 202:57–67.

6. Strauch RJ. Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis: update on evaluation and treatment. J Hand Surg Am. 2011; 36:729–735.

7. Shah CM, Stern PJ. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis. Curr Rev Musculoskelet Med. 2013; 6:9–17.

8. Trumble TE, Rafijah G, Alexander H, Waitayawinyu T. Scaphoidectomy and capsulodesis for SNAC or SLAC stage II. J Wrist Surg. 2012; 1:129–134.

9. Malizos KN, Koutalos A, Papatheodorou L, Varitimidis S, Kontogeorgakos V, Dailiana Z. Vascularized bone grafting and distal radius osteotomy for scaphoid nonunion advanced collapse. J Hand Surg Am. 2014; 39:872–879.

10. Kiefhaber TR. Management of scapholunate advanced collapse pattern of degenerative arthritis of the wrist. J Hand Surg Am. 2009; 34:1527–1530.

11. Maudsley RH, Chen SC. Screw fixation in the management of the fractured carpal scaphoid. J Bone Joint Surg Br. 1972; 54:432–441.

12. Hidaka Y, Nakamura R. Progressive patterns of degenerative arthritis in scaphoid nonunion demonstrated by threedimensional computed tomography. J Hand Surg Br. 1998; 23:765–770.

13. Ruby LK, Stinson J, Belsky MR. The natural history of scaphoid non-union. A review of fifty-five cases. J Bone Joint Surg Am. 1985; 67:428–432.

14. Sendher R, Ladd AL. The scaphoid. Orthop Clin North Am. 2013; 44:107–120.

15. Moon ES, Dy CJ, Derman P, Vance MC, Carlson MG. Management of nonunion following surgical management of scaphoid fractures: current concepts. J Am Acad Orthop Surg. 2013; 21:548–557.

16. Dacho A, Grundel J, Holle G, Germann G, Sauerbier M. Long-term results of midcarpal arthrodesis in the treatment of scaphoid nonunion advanced collapse (SNAC-Wrist) and scapholunate advanced collapse (SLAC-Wrist). Ann Plast Surg. 2006; 56:139–144.

17. Kent ME, Rehmatullah NN, Young L, Chojnowski AJ. Scaphoid nonunion in the presence of a degenerate carpus: don't rush to salvage surgery. J Hand Surg Eur Vol. 2012; 37:56–60.