Cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion.

Abstract

Cancellous bone harvested from the distal radius has been used in various hand surgeries, but studies on its use in scaphoid waist nonunions are insufficient. We investigated the usefulness of cancellous bone graft from the distal radius and headless screw fixation in unstable scaphoid waist nonunion. Thirty-one patients who underwent cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion with follow-up for at least 1year were included. Bone union time, the number of patients with bone union at six and 12weeks, total number of patients with bone union at last follow-up, and bone union on the computed tomography (CT) image at postoperative sixweeks were evaluated. Further, pre- and postoperative radiological measurements, such as scaphoid length and height, lateral intra-scaphoid angle, and height-to-length ratio, and functional outcomes were compared. Additionally, inter-observer reliability of radiologic parameters was checked. Bone union was achieved in 29 patients. There were two nonunions (6.5%). Bone union time was 10.7 (range, 6-26) weeks. Eighteen (58%) and 25 patients (80.6%) were diagnosed with bone union on the plain radiographs at six and 12weeks, respectively. Twenty-two patients (71%) were diagnosed with bone union on CT performed at sixweeks. Radiological measurements and functional outcomes improved postoperatively. The scaphoid length showed good inter-observer agreement. In treating unstable scaphoid waist nonunion, cancellous bone graft from the distal radius and headless screw fixation achieved 93.5% union and improved radiological measurements as well as functional outcomes.