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Journal of the Korean Society for Surgery of the Hand 2007;12(3):105-113.
Published online September 1, 2007.
Surgical Treatment of Scaphoid Nonunion - Factors of Influencing Outcome -
Duke Whan Chung, Chung Soo Han, Jae Hoon Lee, Boo Kyung Kwon, Jin Sung Park
수근 주상골 불유합의 치료 - 치료 결과에 영향을 미치는 요소를 중심으로 -
정덕환, 한정수, 이재훈, 권부경, 박진성
Abstract
Purpose
This study attempted to investigate the factors that influence the clinical and radiological results for patients who underwent bone graft and internal fixation for treatment of scaphoid nonunion. Materials and Methods: The subject of this study were 45 patients who had been diagnosed with scaphoid nonunion and had undergone internal fixation and bone graft using a Herbert screw or Acutrak screw between March 1997 and March 2006. The average follow-up period was 20.5 months (ranging from 1 year to 8 years and 4 months). The average period from the injury to the surgery was 27.6 months (ranging from 6 months to 10 years). The scaphoid union was determined by a simple radiologic examination. The wrist function was evaluated using the modified Mayo wrist scoring system for patients who achieved union. This study examined the period from injury to surgery, the postoperative immobilization period and the influences of accompanying radioscaphoid arthritis, avascular necrosis and DISI on the clinical results. The Fisher’s exact test was used for analysis. Results: The union rate was 97.8% (44 cases) and the modified Mayo wrist score was 86. The ratio of excellent or good results was 81.8% (36 cases). All patients in the group whose period from injury to surgery was less than 5 years achieved union; but only 85.7% of patients in the group whose period from injury to surgery was over 5 years achieved union. The average union rate of the 12 cases with concomitant avascular necrosis was 91.7% (11 cases), and the group without avascular necrosis attained a union rate of 100% (33 cases). The immobilization period, accompanying radioscaphoid arthritis, operation method and DISI did not influence the union rate. The average modified Mayo wrist score of the 26 cases whose immobilization period was longer than 6 weeks was 83.4, lower than that of the 18 cases whose immobilization period was 6 weeks or shorter than 6 weeks, which was 91.3 (p<0.05). The average modified Mayo wrist score of the seven cases whose period from injury to surgery was 5 years or longer was 81.6, whereas that of the 37 cases whose period from injury to surgery was shorter than 5 years was 87.4 (p<0.05). The average modified Mayo wrist score of the eight cases with concomitant radioscaphoid arthritis was 79.7, lower than that of the 36 cases without radioscaphoid arthritis which was 88.5 (p<0.05). Regarding the operation method, the average modified Mayo wrist score of the nine cases who did not undergo bone graft due to lack of fracture gap was 95.4, statistically significantly different from that of the 35 cases who underwent bone graft, which was 84.8. Conclusion: As a treatment for scaphoid nonunion, internal fixation using a Herbert screw or Acutrack screw achieved a high union rate. The factors that influenced the union rate were the period from injury to surgery and avascular necrosis. The factors that influenced wrist function after union were the postoperative immobilization period, the period from injury to surgery, radioscaphoid arthritis, and the fracture gap in the nonunion area.
 


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