In Reply

Abstract

We thank the authors of the letter for their interest and comments. They make 3 basic points. First, with respect to the packing of the cancellous bone graft in a syringe, we do not believe that this changes the graft into anything that simulates structural bone. Packing simply leads to a more uniform consistency that is easier to work with when filling a defect. Although it may increase the graft density, it is still purely cancellous bone and thus does not provide any resistance to compression compared with the use of a corticocancellous strut. The authors next commented on the fully threaded screw design. It is unclear whether this technique depends on the design of the implant. We agree that it would theoretically be best if the screw allowed thread purchase in both the proximal and distal poles to help maintain the position of the reduction. Finally, we agree that our series contained relatively young individuals. However, 3 of the 12 patients were between 24 and 45 years of age, and all healed. We have used this technique for several years since collecting the data for this report, and anecdotally, we have seen no differences in healing between adolescent and young adult patients. This will certainly need to be confirmed by further study. We thank the authors of the letter for their interest and comments. They make 3 basic points. First, with respect to the packing of the cancellous bone graft in a syringe, we do not believe that this changes the graft into anything that simulates structural bone. Packing simply leads to a more uniform consistency that is easier to work with when filling a defect. Although it may increase the graft density, it is still purely cancellous bone and thus does not provide any resistance to compression compared with the use of a corticocancellous strut. The authors next commented on the fully threaded screw design. It is unclear whether this technique depends on the design of the implant. We agree that it would theoretically be best if the screw allowed thread purchase in both the proximal and distal poles to help maintain the position of the reduction. Finally, we agree that our series contained relatively young individuals. However, 3 of the 12 patients were between 24 and 45 years of age, and all healed. We have used this technique for several years since collecting the data for this report, and anecdotally, we have seen no differences in healing between adolescent and young adult patients. This will certainly need to be confirmed by further study. Response to “Scaphoid Waist Nonunion With Humpback Deformity Treated Without Structural Bone Graft”Journal of Hand SurgeryVol. 38Issue 9PreviewWe were interested in the recent article that reported treating scaphoid waist nonunion and humpback deformity with a cancellous rather than a structural bone graft.1 Although the results are promising, we would like to emphasize several points that may affect the general application of the technique. The authors described the use of a nonstructural cancellous bone graft harvested from the ipsilateral distal radius; however, in all cases, the cancellous bone was then compressed within a syringe. Full-Text PDF