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Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius

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Abstract

Purpose

The treatment of delayed union and established nonunion of the scaphoid using a volar approach with impaction of bone graft, either a cancellous or cortico-cancellous wedge graft, for osteosynthesis and maintenance of reduction. With the advancement of instruments and techniques of wrist arthroscopy, wider indications for wrist problems can be solved by this minimally invasive technique. We report our results of arthroscopic reduction, cancellous bone grafting to the regional distal radius, and headless screw fixation for the treatment of scaphoid nonunion, even with humpback deformity.

Methods

Between August 2014 and February 2018, 41 patients (42 wrists) with unstable scaphoid nonunion received arthroscopic surgery. The mean follow-up was 38.1 months (range 24–70 months). We evaluated the results with a function questionnaire and clinical outcomes based on the visual analog scale (VAS) pain score, range of motion and grip strength, and radiologic measurements.

Results

The union rate was 92.6% (38/41 patients) and union time was 4.6 months. Patients regained almost a full range of motion compared with the contralateral wrist. The post-op Quick DASH, Mayo wrist score, and VAS pain score all had significant improvement, with p < 0.05. The scapholunate angle showed significant correction from pre-op 68.0° to post-op 58.3°. The average VAS satisfaction score at final follow-up was 8.7.

Conclusion

Arthroscopic realignment and osteosynthesis for the treatment of unstable scaphoid nonunion with ipsilateral radius bone graft, even with humpback deformity, can achieve a high union rate, good radiological correction, and good functional recovery.

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Acknowledgments

This paper was supported by Taipei Veterans General Hospital. We thank our colleagues and research assistants who provided expertise that greatly assisted the research. We also show our gratitude to the reviewers for your insights and suggestions.

Funding

This study was supported, in part, by grants from the Taipei Veterans General Hospital. The funding institutions had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, Taiwan

    Wei Hsiung, Hui-Kuang Huang, Jung-Pan Wang, Ming-Chau Chang & Yi-Chao Huang

  2. Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, Taiwan

    Wei Hsiung, Hui-Kuang Huang, Jung-Pan Wang, Ming-Chau Chang & Yi-Chao Huang

  3. Department of Orthopaedics, Chiayi Christian Hospital, No.539, Zhongxiao Rd., East Dist., Chiayi City, Taiwan

    Hui-Kuang Huang

  4. Chung Hwa University of Medical Technology, No.89, Wenhua 1st St., Rende Dist., Tainan City, Taiwan

    Hui-Kuang Huang

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  1. Wei Hsiung
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Correspondence to Yi-Chao Huang.

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Hsiung, W., Huang, HK., Wang, JP. et al. Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius. International Orthopaedics (SICOT) 45, 191–197 (2021). https://doi.org/10.1007/s00264-020-04840-2

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