Arch Hand Microsurg 2019; 24(1): 40-49  
Dorsal Approach for Management of Scaphoid Nonunion
Jae Hoon Choi1, Yoon-Min Lee1, Ki-Tae Na2, Han-Vit Kang3, Sang Heon Lee1, Seok-Whan Song1
1Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, 2Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea, 3Department of Orthopedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to: Seok-Whan Song
Department of Orthopedic Surgery, The Catholic University of Korea, Yeouido St. Mary’s Hospital, 10 63-ro, Youngdeungpo-gu, Seoul 07345, Korea
TEL: +82-2-3779-1192, FAX: +82-2-783-0252, E-mail: sw.song@catholic.ac.kr
Received: November 3, 2018; Revised: January 2, 2019; Accepted: January 3, 2019; Published online: March 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

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Abstract
Purpose: To evaluate the clinical and radiological outcomes of scaphoid nonunion patients who had treated by open reduction and internal fixation with iliac bone graft through dorsal approach.
Methods: We retrospectively reviewed medical records and radiographs of 53 patients who underwent an iliac crest bone graft and internal fixation through dorsal approach for scaphoid nonunion between 2003 and 2017. Bony union was confirmed in radiographs, and scapholunate, radiolunate, posteroanterior, intrascaphoid, and lateral intrascaphoid angles were measured on preoperative and last follow-up radiographs. Functional results were evaluated by range of motion, visual analogue scale, and modified Mayo wrist score.
Results: There were 51 men and 2 women with average age of 31.2 years (range, 13-61 years). The mean time from initial injury to surgery was 16.8 months (range, 3-50 months) and mean follow-up period after the operation was 26.2 months (range, 12-76 months). Fifty of 53 patients (94.3%) showed radiographic union at an average time of 15.1 weeks (range, 8-50 weeks). The mean scapholunate angle was significantly changed from 69.3° preoperatively to 54.0° at last follow-up. The mean radiolunate angle was significantly changed from 14.3° preoperatively to 7.2° at last follow-up. The mean posteroanterior intrascaphoid angle was significantly changed from 33.2° preoperatively to 30.2° at last follow-up. The mean lateral intrascaphoid angle was significantly changed from 42.9° preoperatively to 28.8° at last follow-up.
Conclusion: Dorsal approach with iliac bone graft and internal fixation was a reliable method for scaphoid nonunion to achieve bony union with satisfactory clinical and radiological outcomes.
Keywords: Scaphoid, Nonunion, Dorsal approach, Iliac bone graft


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