Mini-Incision Fixation of Nondisplaced Scaphoid Fracture Nonunions

Abstract

Scaphoid nonunions are commonly repaired by an open surgical technique involving debridement, bone grafting, and internal fixation. The purpose of our study is to describe a small subset of scaphoid nonunions that are nondisplaced and might be suitable for a more limited, minimally invasive technique that might offer good results while potentially reducing soft tissue injury. Nine patients seen over a 3-year period by a single surgeon were identified as having scaphoid nonunions without radiographic evidence of displacement, angulation, degenerative changes, osteonecrosis, or carpal instability. Two additional patients with well-aligned delayed unions of 4 months' duration were also studied. All had surgery through a tiny dorsal incision with reaming, local cancellous bone grafting, re-reaming, and compression screw fixation. This was performed under fluoroscopy but without arthroscopy. Pain, range of motion, and grip strength as well as radiographic evidence of healing were recorded. Patients treated for nonunions were followed up for an average of 27 months (range 10-45 months), and all 9 fractures healed at a mean time of 3 months. At final follow-up, there were no radiographic signs of nonunion. The mean arc of wrist motion was 124 degrees, or 91% of that of the contralateral, normal wrist. The mean postoperative grip strength was 29 kgf, or 85% of the value in the opposite hand. At final follow-up, all but 1 patient were pain free, and none had evidence of progression of degenerative changes or carpal instability on final radiographs. The 2 delayed union cases healed at 2 and 3 months with similar postoperative functional measurements. There were no complications. Uncomplicated scaphoid nonunions that are nondisplaced and nonangulated are candidates for the minimally invasive bone grafting and compression screw fixation procedure described. Patients who fit the strict inclusion criteria can expect a reliable healing rate and good functional outcome with a more limited procedure. Therapeutic IV.