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Cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion

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Abstract

Purpose

Cancellous bone harvested from the distal radius has been used in various hand surgeries, but studies on its use in scaphoid waist nonunions are insufficient. We investigated the usefulness of cancellous bone graft from the distal radius and headless screw fixation in unstable scaphoid waist nonunion.

Methods

Thirty-one patients who underwent cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion with follow-up for at least 1 year were included. Bone union time, the number of patients with bone union at six and 12 weeks, total number of patients with bone union at last follow-up, and bone union on the computed tomography (CT) image at postoperative six weeks were evaluated. Further, pre- and postoperative radiological measurements, such as scaphoid length and height, lateral intra-scaphoid angle, and height-to-length ratio, and functional outcomes were compared. Additionally, inter-observer reliability of radiologic parameters was checked.

Results

Bone union was achieved in 29 patients. There were two nonunions (6.5%). Bone union time was 10.7 (range, 6–26) weeks. Eighteen (58%) and 25 patients (80.6%) were diagnosed with bone union on the plain radiographs at six and 12 weeks, respectively. Twenty-two patients (71%) were diagnosed with bone union on CT performed at six weeks. Radiological measurements and functional outcomes improved postoperatively. The scaphoid length showed good inter-observer agreement.

Conclusions

In treating unstable scaphoid waist nonunion, cancellous bone graft from the distal radius and headless screw fixation achieved 93.5% union and improved radiological measurements as well as functional outcomes.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea

    Joo-Yul Bae, Shin Woo Choi & Myeong Geun Song

  2. Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Wonsun Lee & Jae Kwang Kim

  3. Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, Gangneung, Korea

    Jae-Seok Song

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Contributions

JYB: writing the manuscript.

SWC: conception and design, analysis and interpretation of data.

WSL: acquisition of data.

MGS: acquisition of data.

JSS: analysis and interpretation of data.

JKK: conception and design, critical revision of the manuscript and final approval of the version to be submitted.

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Correspondence to Jae Kwang Kim.

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Bae, JY., Choi, S.W., Lee, W. et al. Cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion. International Orthopaedics (SICOT) 48, 487–493 (2024). https://doi.org/10.1007/s00264-023-05998-1

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