Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion
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Since proximal pole fractures of the scaphoid are frequently overlooked, the poor vascularity in the proximal pole fragment often leads to nonunion. Vascularized bone grafts have been recently tested in cases with scaphoid proximal pole nonunion, but the indication for this treatment has not been well established. Alternatively, we have been treating such patients with a non-vascularized iliac bone graft and Herbert-type screw fixation with considerable success. The purpose of this investigation is to evaluate these cases retrospectively and clarify the surgical efficacy of our procedure.
Between 1996 and 2009, 11 consecutive patients with proximal pole scaphoid nonunion were treated with a non-vascularized corticocancellous iliac bone graft and Herbert-type screw fixation. They were all male aged from 12 to 26 years. In two patients, avascular changes were recognized in the proximal pole in preoperative radiographs or MRI. Follow-up ranged from 12 to 76 months.
Bone union was radiographically confirmed in all patients, who returned to their former activities without any complications. The period from operation to union ranged from 12 to 24 weeks. The mean Mayo modified wrist score was 76.4 points preoperatively and 91.4 points postoperatively, and was improved in all cases.
A non-vascularized iliac bone graft with Herbert-type screw fixation obtained satisfactory clinical and radiographic results in cases with scaphoid proximal pole nonunion, regardless of the vascularity in the proximal fragment.
- Dwyer FC. Excision of the carpal scaphoid for ununited fracture. J Bone Joint Surg. 1949;31:572–7.
- Wagner CJ. Fractures of the carpal navicular. J Bone Joint Surg. 1952;34A:774–84.
- Zemel NP, Stark HH, Ashworth CR, Rickard TA, Anderson DR. Treatment of selected patients with an ununited fracture of the proximal part of the scaphoid by excision of the fragment and insertion of a carved silicone-rubber spacer. J Bone Joint Surg. 1984;66A:510–7.
- Swanson AB, de Groot Swanson G, Maupin BK, Moss SH, Ganzhorn RW, Crane MW, Gonzalez MH, Page BJ. Scaphoid implant resection arthroplasty. Long-term results. J Arthroplasty. 1986;1:47–62. CrossRef
- Frykman GK, Taleisnik J, Peters G, Kaufman R, Helal B, Wood VE, Unsell RS. Treatment of nonunited scaphoid fractures by pulsed electromagnetic field and cast. J Hand Surg. 1986;1:344–9.
- Cooney WP 3rd, Dobyns JH, Linscheid RL. Nonunion of the scaphoid: analysis of the results from bone grafting. J Hand Surg. 1980;5A:343–54.
- Stark HH, Rickard TA, Zemel NP, Ashworth CR. Treatment of ununited fractures of the scaphoid by iliac bone grafts and Kirschner-wire fixation. J Bone Joint Surg. 1988;70A:982–91.
- Sauerbier M, Günther C, Bickert B, Pelzer M, Germann G. Long-term outcome of reconstruction of proximal scaphoid pseudarthroses with Matti-Russe-plasty. Handchir Mikrochir Plast Chir. 1999;31:182–6. CrossRef
- Steichen JB, Schreiber DR. Radial bone graft with prolonged immobilization for scaphoid nonunions. Contemp Orthop. 1986;12:19–24.
- DeMaagd RL, Engber WD. Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions. J Hand Surg. 1989;14A:996–1003.
- Megerle K, Keutgen X, Müller M, Germann G, Sauerbier M. Treatment of scaphoid non-unions of the proximal third with conventional bone grafting and mini-Herbert screws: an analysis of clinical and radiological results. J Hand Surg. 2008;33E:179–85.
- Inoue G, Shionoya K, Kuwahata Y. Ununited proximal pole scaphoid fractures. Treatment with a Herbert screw in 16 cases followed for 0.5–8 years. Acta Orthop Scand. 1997;68:124–7. CrossRef
- Bertelli JA, Tacca CP, Rost JR. Thumb metacarpal vascularized bone graft in long-standing scaphoid nonunion-a useful graft via dorsal or palmar approach: a cohort study of 24 patients. J Hand Surg. 2004;29A:1089–97.
- Boyer MI, von Schroeder HP, Axelrod TS. Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg. 1998;23B:686–90.
- Gabl M, Reinhart C, Pechlaner S, Hussl H. Proximal scaphoid pseudarthrosis with avascular pol fragment: long-term outcome after reconstruction with microvascular pedicled iliac crest bone graft. Handchir Mikrochir Plast Chir. 1999;31:196–9. CrossRef
- Sotereanos DG, Darlis NA, Dailiana ZH, Sarris IK, Malizos KN. A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis. J Hand Surg. 2006;31A:580–7.
- Waitayawinyu T, McCallister WV, Katolik LI, Schlenker JD, Trumble TE. Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg. 2009;34A:387–94.
- Waters PM, Stewart SL. Surgical treatment of nonunion and avascular necrosis of the proximal part of the scaphoid in adolescents. J Bone Joint Surg. 2002;84A:915–20.
- Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg. 1994;19A:143–54.
- Schernberg F, Elzein F. Fracture types and fragment dislocations of the scaphoid bone of the hand. Handchir Mikrochir Plast Chir. 1987;19:59–66.
- Minne J, Depreux R, Mestdagh H, Lecluse P. Arterial pedicles of ossa carpi. Lille Med. 1973;18:1174–85.
- Taleisnik J, Kelly PJ. The extraosseous and intraosseous blood supply of the scaphoid bone. J Bone Joint Surg. 1966;48A:1125–37.
- Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg. 1980;5A:508–13.
- Schmitt R, Heinze A, Fellner F, Obletter N, Strühn R, Bautz W. Imaging and staging of avascular osteonecroses at the wrist and hand. Eur J Radiol. 1997;25:92–103. CrossRef
- Sakuma M, Nakamura R, Imaeda T. Analysis of proximal fragment sclerosis and surgical outcome of scaphoid non-union by magnetic resonance imaging. J Hand Surg. 1995;20B:201–5.
- Trumble TE. Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology. J Hand Surg. 1990;15A:557–64.
- Merrell GA, Wolfe SW, Slade JF 3rd. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg. 2002;27A:685–91.
- Moritomo H, Viegas SF, Elder KW, Nakamura K, Dasilva MF, Boyd NL, Patterson RM. Scaphoid nonunions: a 3-dimensional analysis of patterns of deformity. J Hand Surg. 2000;25A:520–8.
- Gereli A, Nalbantoglu U, Sener IU, Kocaoglu B, Turkmen M. Comparison of headless screws used in the treatment of proximal nonunion of scaphoid bone. Int Orthop. 2010; Epub ahead of print.
- Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion
Journal of Orthopaedic Science
Volume 16, Issue 6 , pp 749-755
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- 1. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- 2. Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 14 Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan