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

Affiliations
  • 1Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea. Kangho56@yuhs.ac

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
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