Excellent Results After Bone Grafting and K-Wire Fixation for Scaphoid Nonunion Surgery in Skeletally Immature Patients

Abstract

Scaphoid nonunion is relatively rare in children and adolescents, and no long-term follow-up has been reported. Retrospective follow-up study. Eleven patients (10 boys and 1 girl), mean 15.2 (13.9-15.9) years of age, with scaphoid nonunion and open growth plates were operated with bone grafting, Kirschner-wire fixation and 12 weeks of cast immobilization. Bony union, degenerative wrist changes, and restoration of the carpal architecture were assessed with CT and radiographs. Clinical parameters included active range of motion, grip strength, key pinch strength, and subjective outcome scores (quick disabilities of arm, shoulder and hand (DASH), visual analog scale). The patients were followed up after mean 6.9 (3.1-15.1) years; all patients attended. Radiographs and CT confirmed healing of all nonunions, the carpal anatomy was restored, and the wrists were rated as 0 according to the scaphoid nonunion advanced collapse, without degenerative changes. The clinical result was excellent with visual analog scale at rest = 1, at activity = 6, and quick DASH score = 3.3. Active range of motion and grip strength were insignificantly reduced (14 degrees and 2 kg); the key pinch strength remained similar. Healing of a scaphoid nonunion can be expected in adolescents after open reduction, Kirschner-wire fixation, bone grafting, and plaster immobilization, resulting in pain relief and excellent wrist function without degenerative changes after longer term follow-up. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.