Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis.

Abstract

Background: Current treatment options for persistent scaphoid nonunion are limited to salvage procedures such as proximal row carpectomy (PRC) or 4-corner fusion (4CF). Several small studies have demonstrated that distal scaphoid excision may provide a simpler alternative with faster recovery. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for symptomatic scaphoid nonunion. Methods: The MEDLINE and PubMed databases were searched for the use of distal scaphoid excision in scaphoid nonunions. Studies included reported on either the functional or patient-centered outcomes following distal scaphoid excision for symptomatic scaphoid nonunion. Results: Six articles described the outcomes of 70 patients with an average of 11.7 patients per study. Functional outcomes including flexion-extension arc, radial-ulnar deviation, and grip strength improved by an average of 98.95%, 58.96%, and 131.08%, respectively. Patient-derived outcomes included the Modified Mayo Wrist Score, which improved by 92.6%, and the Disabilities of the Arm, Shoulder and Hand, which improved by 137.17%. An average of 68.75% of patients experience complete relief of pain with 20.83% of patients experiencing pain with strenuous activity. The average postoperative visual analog scale (0-10) was 0.71. On average, 93.33% of patients returned to work with an average time of return being 6.89 weeks. Complete satisfaction was reported by 87.80% of patients. Complications included progression into 4CF or PRC and newly developed midcarpal arthritis. Conclusions: Given favorable outcomes, our analysis suggests that distal scaphoid excision may be a favorable, low-risk treatment for scaphoid nonunion without eliminating more extensive options such as 4CF and wrist arthrodesis.