Arch Hand Microsurg 2018; 23(1): 35-45  
Operative Treatment for Nonunion of the Distal Scaphoid
Sang-yun Lee, Jucheol Shin, Won-taek Oh, Yun-Rak Choi, Il-Hyun Koh, Ho-Jung Kang
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: Ho-Jung Kang
Department of Orthopaedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
TEL: +82-2-2019-3412, FAX: +82-2-573-5393, E-mail: KANGHO56@yuhs.ac
Received: December 15, 2017; Revised: January 25, 2018; Accepted: January 31, 2018; Published online: March 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: The purpose of this study was to analyze the clinical and radiological outcomes of distal scaphoid nonunion patients who underwent operative treatment.
Methods: From July 2006 to May 2014, there were a total of 9 distal scaphoid nonunion patients, with a mean age of 32 years. The mean time from symptom onset to operation was 15 months. Operative treatment was performed through a volar approach, osteosynthesis with an auto-iliac bone graft was performed. Union was determined through radiographs and computed tomography, while the scapholunate angle (SLA) and lateral intrascaphoid angle (LISA) were measured. Clinical outcomes were evaluated by assessing range of motion (ROM) of the wrist, the visual analogue scale (VAS), Mayo wrist score, and disabilities of arm, shoulder and hand (DASH) score.
Results: The incidence of distal scaphoid nonunion was 11.8% (9/76), with all patients demonstrating union after the operation. Mean union time was 5 months and mean follow-up period was 23 months. Both SLA and LISA decreased, returning to normal range. The ROM of the wrist joint increased but not statistically significant. The postoperative VAS pain score improved, while grip strength advanced. In addition, both postoperative Mayo wrist and DASH scores document better results than those of pre-operation. Overall, there were two postoperative complication cases of joint motion limitation and pin site irritation.
Conclusion: Osteosynthesis with auto-iliac bone graft for nonunion of the distal scaphoid showed good clinical and radiological outcomes. Thus, it is considered a recommendable operation in the treatment of distal scaphoid nonunion.
Keywords: Scaphoid nonunion, Distal pole, Osteosynthesis


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