Long-term Results of Proximal Pole Scaphoid Nonunion Treated with Retrograde Fixation and Non-vascularized Cancellous Bone Autograft

Year 2024, Issue: Early Access

Mehmet Arıcan

https://doi.org/10.18678/dtfd.1543997

Abstract

Aim: To evaluate the long-term clinical and functional results of patients diagnosed with scaphoid bone proximal pole nonunion and who underwent retrograde fixation with non-vascularized cancellous autograft from the distal radius and a cannulated, headless screw via a volar approach.
Material and Methods: Twenty-nine patients, 2 female, and 27 male, who underwent surgery with the diagnosis of scaphoid proximal pole nonunion were evaluated in this study. All patients underwent retrograde fixation with a non-vascularized cancellous autograft from the distal radius and a headless cannulated screw using a volar approach and the same rehabilitation program was applied. The clinical and functional scores of the patients were evaluated before surgery and at the last follow-up.
Results: The mean age of the patients was 30.66±7.34 (range, 18-40) years. The median symptom duration was 11 (range, 6-18), and the median follow-up period after surgery was 55 (range, 36-67) months. When the maximum isometric strength of the forearm muscles of the healthy and surgical sides was evaluated at the last follow-up, the mean hand-grip strength test values of the healthy side were significantly higher than the pathological side (p<0.001). In addition, the mean flexion and radial deviation values of the healthy side were found to be statistically significantly higher than the surgical side in terms of the wrist joint range of motion at the last follow-up (p=0.006, and p=0.022, respectively).
Conclusion: Non-vascularized cancellous autograft and retrograde fixation with a volar approach is an effective surgical treatment option for proximal pole nonunion of the scaphoid bone.

Keywords

Scaphoid nonunion, proximal pole, retrograde fixation, non-vascularized cancellous bone autograft

Retrograd Fiksasyon ve Vaskülerize Olmayan Kansellöz Kemik Otogrefti ile Tedavi Edilen Proksimal Kutup Skafoid Kaynamamasının Uzun Dönem Sonuçları

Abstract

Amaç: Skafoid kemik proksimal kutup kaynamama tanısı almış olan ve volar yaklaşımla distal radiusdan nonvaskülarize kanselloz otogreft ve bir adet kanüllü, başsız vida ile retrograd fiksasyon uygulanan hastaların uzun dönem klinik ve fonksiyonel sonuçlarını değerlendirmektir.
Gereç ve Yöntemler: Bu çalışmada skafoid proksimal kutup kaynamama tanısı ile cerrahi yapılan, 2 kadın ve 27 erkek olmak üzere yirmi dokuz hasta değerlendirildi. Tüm hastalara volar yaklaşımla distal radiustan nonvaskülarize kanselloz otogreft ve bir adet başsız kanüllü vida ile retrograd fiksasyon yapıldı ve aynı rehabilitasyon programı uygulandı. Hastaların klinik ve fonksiyonel skorları cerrahi öncesi ve son kontrolde değerlendirildi.
Bulgular: Hastaların ortalama yaşı 30,66±7,34 (aralık, 18-40) yıl idi. Ortanca semptom süresi 11 (aralık, 6-18) ay ve cerrahi sonrası ortanca takip süresi 55 (aralık, 36-67) ay idi. Son kontrolde sağlam ve cerrahi uygulanan tarafların ön kol kaslarının maksimum izometrik kuvveti değerlendirildiğinde, sağlam tarafın ortalama el kavrama gücü test değerleri patolojik tarafa göre anlamlı derecede daha yüksekti (p<0,001). Buna ek olarak, son kontrolde el bilek eklem hareket açıklığı açısından sağlam tarafın ortalama fleksiyon ve radial deviasyon değerlerinin cerrahi uygulanan tarafa göre istatistiksel olarak anlamlı derecede daha yüksek olduğu bulundu (sırasıyla p=0,006 ve p=0,022).
Sonuç: Skafoid kemik proksimal kutup kaynamama durumunda, volar yaklaşımla nonvaskülarize kanselloz otogreft ve retrograd fiksasyon etkili bir cerrahi tedavi seçeneğidir.

Keywords

Skafoid kaynamaması, proksimal kutup, retrograd fiksasyon, nonvaskülerize kansellöz kemik otogrefti

References

• Rhee PC, Jones DB Jr, Shin AY, Bishop AT. Evaluation and treatment of scaphoid nonunions: a critical analysis review. JBJS Rev. 2014;2(7):e4.
• Huang YC, Liu Y, Chen TH. Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert's screw fixation--a study of 49 patients for at least five years. Int Orthop. 2009;33(5):1295-300.
• Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci. 2006;11(4):424-31.
• Yeo JH, Kim JY. Surgical strategy for scaphoid nonunion treatment. J Hand Surg Asian Pac Vol. 2018;23(4):450-62.
• Ammori MB, Elvey M, Mahmoud SS, Nicholls AJ, Robinson S, Rowan C, et al. The outcome of bone graft surgery for nonunion of fractures of the scaphoid. J Hand Surg Eur Vol. 2019;44(7):676-84.
• Rogers MJ, Ohlsen SM, Huang JI. Fixation techniques for scaphoid nonunion. J Am Acad Orthop Surg. 2023;31(15):783-92.
• Taleisnik J, Kelly PJ. The extraosseous and intraosseous blood supply of the scaphoid bone. J Bone Joint Surg Am. 1966;48(6):1125-37.
• Aibinder WR, Wagner ER, Bishop AT, Shin AY. Bone grafting for scaphoid nonunions: is free vascularized bone grafting superior for scaphoid nonunion? Hand (N Y). 2019;14(2):217-22.
• Papatheodorou LK, Papadopoulos DV, Graber MM, Sotereanos DG. Dorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis. Injury. 2021;52(12):3635-9.
• Miller EA, Huang JI. Traditional bone grafting in scaphoid nonunion. Hand Clin. 2024;40(1):105-16.
• Daly CA, Boden AL, Hutton WC, Gottschalk MB. Biomechanical strength of retrograde fixation in proximal third scaphoid fractures. Hand (N Y). 2019;14(6):760-4.
• Duncumb JW, Robinson PG, Williamson TR, Murray IR, Campbell D, Molyneux SG, et al. Bone grafting for scaphoid nonunion surgery: a systematic review and meta-analysis. Bone Joint J. 2022;104-B(5):549-58.
• Rancy SK, Wolfe SW, Jerome JTJ. Predictors of failure for vascularized and nonvascularized bone grafting of scaphoid nonunions: a systematic review. J Hand Microsurg. 2021;14(4):322-35.
• Fujihara Y, Yamamoto M, Hidaka S, Sakai A, Hirata H. Vascularised versus non-vascularised bone graft for scaphoid nonunion: Meta-analysis of randomised controlled trials and comparative studies. JPRAS Open. 2022;35:76-88.
• Reigstad O, Grimsgaard C, Thorkildsen R, Reigstad A, Rokkum M. Long-term results of scaphoid nonunion surgery: 50 patients reviewed after 8 to 18 years. J Orthop Trauma. 2012;26(4):241-5.
• Jaminet P, Götz M, Gonser P, Schaller HE, Lotter O. Treatment of scaphoid nonunion: radiologic outcome of 286 patients in 10 years. Eplasty. 2019;19:e5.
• Ribak S, Medina CE, Mattar R Jr, Ulson HJ, Ulson HJ, Etchebehere M. Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius. Int Orthop. 2010;34(5):683-8.
• Tambe AD, Cutler L, Murali SR, Trail IA, Stanley JK. In scaphoid non-union, does the source of graft affect outcome? Iliac crest versus distal end of radius bone graft. J Hand Surg Br. 2006;31(1):47-51.
• Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol. 2018;43(1):32-40.
• Luchetti TJ, Rao AJ, Fernandez JJ, Cohen MS, Wysocki RW. Fixation of proximal pole scaphoid nonunion with non-vascularized cancellous autograft. J Hand Surg Eur Vol. 2018;43(1):66-72.
• McInnes CW, Giuffre JL. Fixation and grafting after limited debridement of scaphoid nonunions. J Hand Surg Am. 2015;40(9):1791-6.
• Wagner ER, Spencer CC, Dawes AM, Gottschalk MB, Daly CA. Management of proximal pole scaphoid nonunions: a critical analysis review. JBJS Rev. 2021;9(4):e19.00181.
• Waters PM, Stewart SL. Surgical treatment of nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents. J Bone Joint Surg Am. 2002;84(6):915-20.
• Severo AL, Lemos MB, Lech OLC, Barreto Filho D, Strack DP, Candido LK. Bone graft in the treatment of nonunion of the scaphoid with necrosis of the proximal pole: a literature review. Rev Bras Ortop. 2017;52(6):638-43.
• Matsuki H, Ishikawa J, Iwasaki N, Uchiyama S, Minami A, Kato H. Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion. J Orthop Sci. 2011;16(6):749-55.
• Merrell GA, Wolfe SW, Slade JF 3rd. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am. 2002;27(4):685-91.
• Weber MB, Bishop AT, Shin AY. Osteochondral autograft transplantation for proximal pole scaphoid nonunions. J Hand Surg Am. 2023;48(7):655-64.
• Finsen V, Hofstad M, Haugan H. Most scaphoid non-unions heal with bone chip grafting and Kirschner-wire fixation. Thirty-nine patients reviewed 10 years after operation. Injury. 2006;37(9):854-9.
• Jeon IH, Micic ID, Oh CW, Park BC, Kim PT. Percutaneous screw fixation for scaphoid fracture: a comparison between the dorsal and the volar approaches. J Hand Surg Am. 2009;34(2):228-36.e1.
• Lim TK, Kim HK, Koh KH, Lee HI, Woo SJ, Park MJ. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting. J Hand Surg Am. 2013;38(10):1906-12.e1.
• Daecke W, Wieloch P, Vergetis P, Jung M, Martini AK. Occurrence of carpal osteoarthritis after treatment of scaphoid nonunion with bone graft and Herbert screw: a long-term follow-up study. J Hand Surg Am. 2005;30(5):923-31.