International Orthopaedics

, Volume 42, Issue 5, pp 1099–1106 | Cite as

Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment?

Original Paper

Abstract

Purpose

Conventional bone grafting and Herbert screw fixation give satisfactory results for scaphoid nonunion; however, vascularized bone grafting has superior results, especially in the case of avascular necrosis of proximal fragment. Vascularized bone grafting is technically more demanding with small error of margin, problems of getting the appropriate graft, fixation and incorporation, and requires longer duration for wrist immobilization.

Methods

Forty-five patients of scaphoid nonunion were treated by cancellous bone grafting, cortex containing graft if required and Herbert screw fixation. Functional outcomes were assessed at the latest follow up after surgery (minimum one year after surgery).

Results

The average pre-operative and post-operative scapho-lunate angle, grip strength, flexion-extension movement, radio-ulnar movement, scaphoid index and modified mayo score were improved from 49.60 ± 6.40° (37–66) to 36.26 ± 4.73° (range 28–46), 20.66 ± 3.17 kg (15–27) to 31.11 ± 3.29 kg (range 25–40), 78.57 ± 14.22° (45–110) to 132.86 ± 13.90° (100–165), 30.06 ± 6.06° (20–44) to 44.95 ± 6.37°(range 35–59), 0.66 ± 0.076 (0.55–0.79) to 0.60 ± 0.065 (range 0.49–0.73) and 58.66 ± 5.24 (50–70) to 84.37 ± 5.01 (range 75–95), respectively, with P value <0.001. Based on modified mayo score, 21 (46.7%) patients had excellent results, 19 (42.2%) had good results, 4 (8.9%) had fair results and one patient (2.2%) had poor results.

Conclusion

Bone grafting and Herbert screw fixation provides a good option for treatment of scaphoid nonunion, especially in the absence of avascular necrosis of proximal fragment. More importantly, vascularized bone grafting in all scaphoid nonunion may not be necessary and could otherwise have been united uneventfully by this technique. However, avascular necrosis of proximal fragment must be ruled out pre-operatively as well as intra-operatively.

Keywords

Bone grafting Functional outcomes Herbert screw Scaphoid nonunion 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was taken from all individual participants included in the study.

References

  1. 1.
    Chang M, Bishop A, Moran S (2006) The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg [Am] 31:387–396CrossRefGoogle Scholar
  2. 2.
    Bervian MR, Ribak S, Livani B (2015) Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery. Int Orthop 39:67–72CrossRefPubMedGoogle Scholar
  3. 3.
    Bindra R, Bednar M, Light T (2008) Volar wedge grafting for scaphoid nonunion with collapse. J Hand Surg [Am] 33:974–979CrossRefGoogle Scholar
  4. 4.
    Kilici A, Sokucu S, Parmaksiz AS, Gul M, Kabukcu YS (2011) Comparative evaluation of radiographic and functional outcomesin the surgical treatment of scaphoid non-unions. Acta Orthop Traumatol Turc 45(6):399–405CrossRefGoogle Scholar
  5. 5.
    Little CP, Burston BJ, Hopkinson-Woolley J, Burge P (2006) Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg (Br) 31:252–255CrossRefGoogle Scholar
  6. 6.
    Waitayawinyu T, Pfaeffle HJ, McCallister WV, Nemechek NM, Trumble TE (2007) Management of scaphoid nonunions. Orthop Clin N Am 38:237–249CrossRefGoogle Scholar
  7. 7.
    Taljanovic M, Karantanas A, Griffith JF, DeSilva GL, Rieke JD, Sheppard JE (2012) Imaging and treatment of scaphoid fractures and their complications. Semin Musculoskelet Radiol 16(2):159–174CrossRefPubMedGoogle Scholar
  8. 8.
    Geissler W, Adams JE, Bindra RR, Lanzinger WD, Slutsky DJ (2012) Scaphoid fractures: what’s hot, what’s not. Instr Course Lect 61:71–84PubMedGoogle Scholar
  9. 9.
    Warren-Smith CD, Barton NJ (1988) Non-union of the scaphoid: Rüsse graft vs. Herbert screws. J Hand Surg (Br) 13(1):83–86CrossRefGoogle Scholar
  10. 10.
    Zakzouk SA, Khanfour AA (2014) Scaphoid nonunion volar pedicle vascularized graft versus volar peg graft. Egypt Orthop J 49:53–60CrossRefGoogle Scholar
  11. 11.
    Chang MA, Bishop AT, Moran SL, Shin AY (2006) The outcomes and complications of 1,2 intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg 31A:387–396CrossRefGoogle Scholar
  12. 12.
    Huang Y-C, Liu Y, Chen T-H (2009) Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert’s screw fixation—a study of 49 patients for at least five years. Int Orthop 33:1295–1300CrossRefPubMedGoogle Scholar
  13. 13.
    McRae R (1987) The hand, clinical orthopedic examination, 2nd edn. Edinburgh, London, pp 56–70Google Scholar
  14. 14.
    Kawamura K, Chung KC (2008) Treatment of scaphoid fractures and nonunions. J Hand Surg [Am] 33:988–997CrossRefGoogle Scholar
  15. 15.
    Buijze G, Ochtman L, Ring D (2012) Management of scaphoid nonunion. J Hand Surg [Am] 37(5):1095–1100CrossRefGoogle Scholar
  16. 16.
    Green DP (1985) The effects of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg 10A:597–605CrossRefGoogle Scholar
  17. 17.
    Russe O (1960) Fracture of the carpal navicular. Diagnosis, nonoperative treatment, and operative treatment. J Bone Joint Surg Am 42-A:759–768CrossRefPubMedGoogle Scholar
  18. 18.
    Filan SL, Herbert TJ (1996) Herbert screw fixation of scaphoid fractures. J Bone Joint Surg (Br) 78(4):519–529CrossRefGoogle Scholar
  19. 19.
    Daly K, Magnussen PA, Simonis RB (1996) Established nonunion of the scaphoid treated by volar wedge grafting and Herbert screw fixation. J Bone Joint Surg (Br) 78(4):530–534CrossRefGoogle Scholar
  20. 20.
    Bilic R, Simic P, Jelic M, Stern-Padovan R, Dodig D, van Meerdervoort H, Martinovic S, Ivankovic D, Pecina M, Vukicevic S (2006) Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 30(2):128–134CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lee SK, Byun DJ, Roman-Deynes JL, Model Z, Wolfe SW (2015) Hybrid Russe procedure for Scaphoid waist fracture nonunion with deformity. J Hand Surg [Am] 40(11):2198–2205CrossRefGoogle Scholar
  22. 22.
    Braga-Silva J, Peruchi FM, Moschen GM, Gehlen D, Padoin AV (2008) A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures. J Hand Surg Eur Vol 33:636–640CrossRefPubMedGoogle Scholar
  23. 23.
    Hirche C, Xiong L, Heffinger C, Munzberg M, Fischer S, Kneser U, Kremer T (2017) Vascularized versus non-vascularized bone grafts in the treatment of scaphoid non-union: a clinical outcome study with therapeutic algorithm. J Orthop Surg 25(1):1–6CrossRefGoogle Scholar
  24. 24.
    Kang HJ, Chun YM, Koh IH, Par JH, Choi YR (2016) Is arthroscopic bone graft and fixation for Scaphoid nonunions effective? Clin Orthop Relat Res 474(1):204–212CrossRefPubMedGoogle Scholar
  25. 25.
    Gunal Ozçelik A, Gokturk E, Ada S, Demirtafl M (1999) Correlation of magnetic resonance imaging and intraoperative punctate bleeding to assess the vascularity of scaphoid nonunion. Arch Orthop Trauma Surg 119:285–287CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Civil Service HospitalKathmanduNepal

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