Percutaneous Fixation Of Scaphoid Non-union. A systematic Review

Abstract

The primary risk factor for nonunion of the scaphoid is displacement/instability, but delayed or missed diagnosis, inadequate treatment, fracture location, and blood supply are also risk factors. Untreated nonunion leads to degenerative wrist arthritis, the so-called ‘scaphoid nonunion advanced collapse’ wrist. Treatment options vary from percutaneous fixation to open reduction and internal fixation with vascularized or nonvascularized bone grafting to salvage procedures involving excision and/or arthrodesis of carpals. Percutaneous fixation of fractures of the scaphoid is well documented in the acute setting by both dorsal and volar methods. What is not commonly discussed is the use of this method for delayed unions and nonunions of the scaphoid. These techniques can avoid the morbidity of an open approach and division of the carpal ligaments. Seven studies were collected from Febuary to July 2018 on percutaneous fixation of scaphoid nonunion from PubMed, Medscape, and Google Scholar and also from materials available in the Internet covering the years between 2000 and 2017. They were included in the review, as they were deemed eligible by fulfilling the inclusion criteria. All these studies were carried out on humans and discussed the results of percutaneous fixation of scaphoid nonunion and were based on sufficient number of patients and reliable results. Healing was achieved in most cases of scaphoid nonunion treated by this method, provided that there was a good selection of cases appropriate for treatment by percutaneous fixation. Percutaneous fixation in appropriate patients provides satisfactory results with high union and minimal complication rates in scaphoid nonunions. Percutaneous screw fixation is indicated in early scaphoid nonunions without substantial cystic bone resorption, without appreciable collapse of the scaphoid architecture, and without clear avascular necrosis of the proximal pole. Moreover, the scaphoid should be with an intact external cartilaginous shell and normal scapholunate angle without a humpback deformity.