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Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate

  • Handsurgery
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Abstract

Introduction

Scaphoid fractures represent 5–10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability.

Methods

Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6 months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation.

Results

According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8 weeks, while group 2 patients had a slower consolidation, with a mean of 14 weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006).

Conclusion

Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation.

Level of evidence

II, therapeutics studies; prospective comparative study.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to information that could compromise the privacy of research participants.

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Authors and Affiliations

  1. Instituto Vita, São Paulo, SP, Brazil

    João Carlos Nakamoto

  2. Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, SP, Brazil

    Renato Martins Xavier, Felipe Hellmeister Burgos, Erick Yoshio Wataya, Fernanda do Carmo Iwase, Hugo Alberto Nakamoto & Rames Mattar Júnior

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  1. João Carlos Nakamoto
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  2. Renato Martins Xavier
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  4. Erick Yoshio Wataya
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  5. Fernanda do Carmo Iwase
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  6. Hugo Alberto Nakamoto
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Contributions

JCN: conceptualization, project administration, wrote the original draft of the article and participated in the review and editing process. RMX: data curation, conducting the research and investigation process, wrote the original draft of the article and participated in the review and editing process. FHB: data curation, conducting the research and investigation process. EYW: conducting the research and investigation process and validation. FCI: project Administration and validation. HAN: project Administration and validation. RMJ: methodology and supervision.

Corresponding author

Correspondence to Renato Martins Xavier.

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Conflict of interest

The authors inform that there are no previous reports that might be regarded as similar work and no conflict of interest of any kind of relationship and any funding was received.

Ethical approval

This study was approved by Institutional Ethics Committee under opinion number 2.878.925.

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Written informed consent according to the Declaration of Helsinki was obtained from all study participants and in applicable cases their parents or legal guardians.

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Written informed consent was obtained from all patient/parents/legal guardians for publication of this study and any accompanying images and videos. A copy of the written consent is available for review by the Editor of this journal.

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Nakamoto, J.C., Xavier, R.M., Burgos, F.H. et al. Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate. Arch Orthop Trauma Surg 143, 2247–2253 (2023). https://doi.org/10.1007/s00402-022-04625-9

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  • DOI: https://doi.org/10.1007/s00402-022-04625-9

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