Greffe spongieuse et fixation par vis de compression sans tête dans les pseudarthroses du scaphoïde carpien

Abstract

PurposeScaphoid fracture commonly occurs around the mid-third of the scaphoid, and nonunion of this fracture has several treatment options. The authors performed autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack–Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. MethodsMedical records and radiographs of 30 patients who underwent cancellous bone graft and headless compression screw fixation for nonunion of scaphoid waist fracture were retrospectively reviewed. There were 28 men and 2 women, with a mean age of 32.8 years (range, 21–63). The mean time to surgery was 10 months (range, 3–25) and mean follow-up was 37.5 months (range, 15–52). The authors analyzed bony union, lateral intrascaphoid angle, scapholunate angle, radiolunate angle and scaphoid length on radiographs and evaluated the modified mayo wrist score (MMWS) as a functional outcome. ResultsBony union was achieved in all cases. The lateral intrascaphoid angle improved from 40° to 32° (P<0.001). The scapholunate angle also improved from 61° to 56° (P=0.009). The radiolunate angle decreased from 8° to 4° (P=0.048) and scaphoid length increased from 22mm to 26mm (P<0.001) postoperatively. Wrist motion and MMWS improved significantly at last follow-up. However, there were no significant differences between scaphoid deformity correction angle and pre to postoperative difference in MMWS. ConclusionsNonstructural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack–Lichtman type II nonunion in the mid-third of the scaphoid. Level of evidenceLevel III.