Operative Treatment for Nonunion of the Distal Scaphoid

Lee,  Sang yun; Shin,  Jucheol; Oh,  Won taek; Choi,  Yun Rak; Koh,  Il Hyun; Kang,  Ho Jung

doi:2018.23.1.35

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Original Article

Archives of Hand and Microsurgery 2018;23(1):35-45.
Published online March 1, 2018.
DOI: https://doi.org/10.12790/ahm.2018.23.1.35

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. KANGHO56@yuhs.ac

Received: 15 December 2017 • Revised: 25 January 2018 • Accepted: 31 January 2018

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.

Key Words: Scaphoid nonunion, Distal pole, Osteosynthesis

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