J Korean Soc Surg Hand.  2017 Jun;22(2):89-95. 10.12790/jkssh.2017.22.2.89.

The Result of Percutaneous Screw Fixation without Bone Grafting for Scaphoid Waist Nonunion under Local Anesthesia

• Cha JK
• Park JK
• Choi SM
• Yang JY

• KMID: 2383800
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.89

Abstract

PURPOSE
The purpose of this study was to analyze the results of patients with scaphoid waist nonunion treated with percutaneous screw fixation without bone grafting under local anesthesia.
METHODS
We enrolled scaphoid waist nonunion of 15 patients which had no deformity, displacement, evidence of avascular necrosis and bone cyst under 5 mm on its radiological study. All patients were male with an average age of 28.9±6.2 years (range, 17-38 years). The mean time to surgery from initial injury was 10.8±2.2 months (range, 6-14 months). All patients were treated with percutaneous screw fixation without bone grafting via volar approaching under local anesthesia and postoperative radiographs were reviewed and documented the flexion and extension arcs of the injured wrist and uninjured wrist, disability of the arm, shoulder and hand (DASH) score at final follow-up.
RESULTS
All 15 patients showed radiological union at an average 5.5±1.0 months. At 12 months follow-up, the flexion and extension arcs of the injured wrist were 95% and 98.5% of the uninjured wrist. The average DASH score at final follow-up was 7±3.9 (range, 0-15). None of these patients showed any complications associated with surgery.
CONCLUSION
Percutaneous screw fixation without bone grafting under local anesthesia was reliable primary treatment method for scaphoid waist non-union without displacement or deformation in the fracture site.

Keyword

Scaphoid bones; Ununited fractures; Percutaneous; Fracture fixation

MeSH Terms

Anesthesia, Local*
Arm
Bone Cysts
Bone Transplantation*
Congenital Abnormalities
Follow-Up Studies
Fracture Fixation
Fractures, Ununited
Hand
Humans
Male
Methods
Necrosis
Scaphoid Bone
Shoulder
Wrist

Figure

• 

  Fig. 1 Preoperative X-ray shows nonunion and cystic bone lesion at the scaphoid waist in a 26-year-old man who injured 14 months ago. (A) Posteroanterior (PA) view, (B) lateral view, (C) biliard view, and (D) ulnar deviation PA view.

• 

  Fig. 2 Computed tomography (CT) shows 4 mm sized cystic bone resorption and sclerotic change without any deformity in the scaphoid nonunion site at sagittal image.

• 

  Fig. 3 Postoperative 6 months radiographs demonstrates complete bone union.

• 

  Fig. 4 Photographs shows nearly complete recovery of range of motion at the final follow-up.

Reference

1. Geissler WB. Carpal fractures in athletes. Clin Sports Med. 2001; 20:167–188.

2. Cooney WP, Linscheid RL, Dobyns JH, Wood MB. Scaphoid nonunion: role of anterior interpositional bone grafts. J Hand Surg Am. 1988; 13:635–650.

3. Leslie IJ, Dickson RA. The fractured carpal scaphoid: natural history and factors influencing outcome. J Bone Joint Surg Br. 1981; 63:225–230.

4. Szabo RM, Manske D. Displaced fractures of the scaphoid. Clin Orthop Relat Res. 1988; (230):30–38.

5. Freedman DM, Botte MJ, Gelberman RH. Vascularity of the carpus. Clin Orthop Relat Res. 2001; (383):47–59.

6. Lee YK, Woo SH, Ho PC, Park JG, Kim JY. Arthroscopically assisted cancellous bone grafting and percutaneous K-wires fixation for the treatment of scaphoid nonunions. J Korean Soc Surg Hand. 2014; 19:19–28.

7. Dailiana ZH, Malizos KN, Zachos V, Varitimidis SE, Hantes M, Karantanas A. Vascularized bone grafts from the palmar radius for the treatment of waist nonunions of the scaphoid. J Hand Surg Am. 2006; 31:397–404.

8. Rajagopalan BM, Squire DS, Samuels LO. Results of Herbert-screw fixation with bone-grafting for the treatment of nonunion of the scaphoid. J Bone Joint Surg Am. 1999; 81:48–52.

9. Slade JF 3rd, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am. 2003; 85:Suppl 4. 20–32.

10. Park JW. Scaphoid fractures and nonunions: recent trends of treatment. J Korean Soc Surg Hand. 2011; 16:116–126.

11. Streli R. Percutaneous screwing of the navicular bone of the hand with a compression drill screw (a new method). Zentralbl Chir. 1970; 95:1060–1078.

12. Slade JF 3rd, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res. 2006; 445:108–119.

13. Capo JT, Orillaza NS Jr, Slade JF 3rd. Percutaneous management of scaphoid nonunions. Tech Hand Up Extrem Surg. 2009; 13:23–29.

14. Korkala OL, Antti-Poika IU. Late treatment of scaphoid fractures by bone grafting and compression staple osteosynthesis. J Hand Surg Am. 1989; 14:491–495.

15. Gupta A, Risitano G, Crawford RJ, Burke FD. The ununited scaphoid: prognostic factors in delayed and nonunions of the scaphoid. Hand Surg. 1999; 4:11–19.

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

17. Leyshon A, Ireland J, Trickey EL. The treatment of delayed union and non-union of the carpal scaphoid by screw fixation. J Bone Joint Surg Br. 1984; 66:124–127.

18. Barton NJ. Apparent and partial non-union of the scaphoid. J Hand Surg Br. 1996; 21:496–500.

19. Gaebler C, McQueen MM. Carpus fractures and dislocation. In : Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, editors. Rockwood and Green's fractures in adults. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins;2010. p. 782–828.

20. Somerson JS, Fletcher DJ, Srinivasan RC, Green DP. Compression screw fixation without bone grafting for scaphoid fibrous nonunion. Hand (N Y). 2015; 10:450–453.

21. Kim JK, Kim JO, Lee SY. Volar percutaneous screw fixation for scaphoid waist delayed union. Clin Orthop Relat Res. 2010; 468:1066–1071.

22. Mahmoud M, Koptan W. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. J Bone Joint Surg Br. 2011; 93:932–936.