Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

Jung-Pan Wang,Hui-Kuang Huang,Jui-Tien Shih

doi:10.1186/s12891-020-03850-w

Abstract

BackgroundThere are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint.MethodsBetween 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain.ResultsNineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24–120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5o to 67.4o, wrist extension from 62.3o to 71.7o, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82o to 66o. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups.ConclusionsUsing arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.

Highlights

There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment
We retrospectively evaluated cases of proximal scaphoid nonunion that were treated with arthroscopic-assisted bone grafting and headless compression screw fixation across the SL joint
No patients had obvious SL dissociation that was noted during the arthroscopy procedure

Summary

Introduction

There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint. The scaphoid has a unique intraosseous retrograde blood flow, and it connects with the lunate in the proximal row to sustain axial loading of the wrist [1]. SNAC change was found in 97% of patients with at least 5 years of scaphoid nonunion [5]. Treatment for scaphoid nonunion includes non-vascularized bone grafts, pedicle vascularized grafts, free flaps, and total arthroscopic management. The majority of reports for each method indicates high union rates of more than 90%, but there is still debate regarding which treatment is better for patients [2, 3, 6]

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