Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis
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Published:
Feb 20, 2019
Keywords:
Scaphoid, proximal pole, nonunion
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Abstract
Objective: To report the consolidation rate and the outcomes of a series of 22 patients with proximal pole scaphoid nonunion treated with a metaphyseal core decompression and an anterograde self-compressing screw. Methods: We present a prospective series of patients with proximal pole scaphoid nonunion and confirmation of intraoperative bleeding in both fragments. Patients presenting with displacement, degenerative changes, proximal pole fragmentation, cavitation at the fracture site, reduced bone length, and necrosis, as well as those with carpal instability, were excluded. X-rays and computed tomography scans were performed to assess consolidation; range of motion and grip strength were recorded, and patients completed a visual analogue scale for pain at rest, pain during activity, and subjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results: Eighteen patients were included. Union was observed in 17 patients. The average follow-up time was 22 months, and the average final range of motion was as follows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnar deviation, and 85% for grip strength. The average score on the visual analogue scale was 0 for pain at rest, 2 for pain during activity, and 9 for function, while the average DASH score was 8. Conclusions: Using this simple and reliable technique, we obtained a 95% union and very good functional results. Metaphyseal core decompression with an antegrade screw is a valid and effective alternative for treatment of proximal pole scaphoid nonunion in carefully selected patients.
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Rellán, I., Gallucci, G. L., Boretto, J. G., Donndorff, A., Zaidenberg, E. E., & De Carli, P. (2019). Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(1), 46-54. https://doi.org/10.15417/issn.1852-7434.2019.84.1.786
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Clinical Research
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References
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14. Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013;38(4):690-700. DOI: 10.1016/j.jhsa.2013.01.036
15. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. Core decompression of the distal radius for the treatment of Kienböck’s disease: a biomechanical study. J Hand Surg Am 2008;33(9):1478-81. DOI: 10.1016/j.jhsa.2008.06.011
16. Kam B, Topper SM, McLoughlin S, Liu Q. Wedge osteotomies of the radius for Kienböck’s disease: a biomechanical analysis. J Hand Surg Am 2002;27(1):37-42. DOI 10.1053/jhsu.2002.29489
17. Matsuki H, Ishikawa J, Iwasaki N, Uchiyama S, Minami A, Kato H. Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion. J Orthop Sci 2011;16(6):749-55. DOI: 10.1007/s00776-011-0158-8
18. DeMaagd R, Engber W. Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions. J Hand Surg Am 1989;14(6):996-1003. DOI:10.1016/S0363-5023(89)80050-4
19. 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(2):124-7. DOI: 10.3109/17453679709003993
20. Krimmer H. Management of acute fractures and nonunions of the proximal pole of the scaphoid. J Hand Surg Am 2002;27(3):245-8. DOI: 10.1054/jhsb.2001.0736
21. Herbert TJ, Filan SL. Proximal scaphoid nonunion-osteosynthesis. Handchir Mikrochir Plast Chir 1999;31(3):169-73. DOI: 10.1055/s-1999-13516
22. Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am 2004;29(1):74-9.
DOI: 10.1016/j.jhsa.2003.09.002
23. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996;78(12):1829-37. https://insights.ovid.com/jbjs/199612000/00004623-199612000-00005
https://doi.org/10.1016/S0363-5023(80)80087-6
2. Vender MI, Watson HK, Wiener BD, Black DM. Degenerative change in symptomatic scaphoid nonunion. J Hand Surg Am
1987;12(4):514-9. DOI: 10.1016/S0363-5023(87)80198-3
3. Botte MJ, Mortensen WW, Gelberman RH, Rhoades CE, Gellman H. Internal vascularity of the scaphoid in cadavers after insertion of the Herbert screw. J Hand Surg Am 1988;13(2):216-20.
DOI: 10.1016/S0363-5023(88)80051-0
4. Illarramendi AA, Schulz C, De Carli P. The surgical treatment of Kienböck’s disease by radius and ulna metaphyseal core decompression. J Hand Surg Am 2001;26(2):252-60.
DOI: 10.1053/jhsu.2001.22928
5. Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br 1996;78(4):519-29.
DOI: 10.1302/0301-620X.78B4.0780519
6. Schernberg F, Elzein F. [Fracture types and fragment dislocations of the scaphoid bone of the hand]. Handchir Mikrochir Plast Chir 1987;19(2):59-66.
7. De Carli P, Zaidenberg EE, Alfie V, Donndorff A, Boretto JG, Gallucci GL. Radius core decompression for Kienböck disease stage IIIA: outcomes at 13 years follow-Up. J Hand Surg Am 2017;42(9):752.e1-752.e6.
DOI: 10.1016/j.jhsa.2017.05.017
8. McQueen MM, Gelbke MK, Wakefield A, Will EM, Gaebler C. Percutaneous screw fixation versus conservative treatment for fractures of the waist of the scaphoid: A prospective randomised study. J Bone Joint Surg Br. 2008; 90(1):66-71. DOI: 10.1302/0301-620X.90B1.19767
9. http://www.dash.iwh.on.ca/available-translations
10. Merrell GA, Wolfe SW, Slade JF. Treatment of scaphoid nonunions: Quantitative meta-analysis of the literature. J Hand Surg Am 2002;27(4):685-91. DOI: 10.1053/jhsu.2002.34372
11. Kazmers NH, Thibaudeau S, Levin LS. A scapholunate ligament-sparing technique utilizing the medial femoral condyle corticocancellous free flap to reconstruct scaphoid nonunions with proximal pole avascular necrosis. J Hand Surg Am 2016;41(9):e309-15. DOI: 10.1016/j.jhsa.2016.06.004
12. 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 Am 2006;31(4):580-7. DOI: 10.1016/j.jhsa.2006.01.005
13. Lim TK, Kim HK, Koh KH, Lee H Il, Woo SJ, Park MJ. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting. J Hand Surg Am 2013;38(10):1906-12. DOI: 10.1016/j.jhsa.2013.07.025
14. Bürger HK, Windhofer C, Gaggl AJ, Higgins JP. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013;38(4):690-700. DOI: 10.1016/j.jhsa.2013.01.036
15. Sherman GM, Spath C, Harley BJ, Weiner MM, Werner FW, Palmer AK. Core decompression of the distal radius for the treatment of Kienböck’s disease: a biomechanical study. J Hand Surg Am 2008;33(9):1478-81. DOI: 10.1016/j.jhsa.2008.06.011
16. Kam B, Topper SM, McLoughlin S, Liu Q. Wedge osteotomies of the radius for Kienböck’s disease: a biomechanical analysis. J Hand Surg Am 2002;27(1):37-42. DOI 10.1053/jhsu.2002.29489
17. Matsuki H, Ishikawa J, Iwasaki N, Uchiyama S, Minami A, Kato H. Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion. J Orthop Sci 2011;16(6):749-55. DOI: 10.1007/s00776-011-0158-8
18. DeMaagd R, Engber W. Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions. J Hand Surg Am 1989;14(6):996-1003. DOI:10.1016/S0363-5023(89)80050-4
19. 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(2):124-7. DOI: 10.3109/17453679709003993
20. Krimmer H. Management of acute fractures and nonunions of the proximal pole of the scaphoid. J Hand Surg Am 2002;27(3):245-8. DOI: 10.1054/jhsb.2001.0736
21. Herbert TJ, Filan SL. Proximal scaphoid nonunion-osteosynthesis. Handchir Mikrochir Plast Chir 1999;31(3):169-73. DOI: 10.1055/s-1999-13516
22. Chan KW, McAdams TR. Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques. J Hand Surg Am 2004;29(1):74-9.
DOI: 10.1016/j.jhsa.2003.09.002
23. Trumble TE, Clarke T, Kreder HJ. Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws. J Bone Joint Surg Am 1996;78(12):1829-37. https://insights.ovid.com/jbjs/199612000/00004623-199612000-00005