Clinical effect of pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation on the nonunion of scaphoid

Abstract

Background The high incidence of scaphoid nonunion occurs after the scaphoid fracture due to the vulnerable blood supply. The complications of scaphoid nonunion, such as predicatable pattern of carpal collapse and degenerative arthritic will take place without treatment. Patients will suffer from pain of bone and poor functional in the early and late stage of the progression, which can significantly affect quality of life. Therefore, it is of great important to chose an operative technique which can get a high success rate for union. This paper introduced a technique for the treatment of scaphoid nonunion with pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation. Methods A retrospective review a senior surgeon's internship at a private university from 2010 to 2021 was performed. Demographic information and the characteristics of patients were obtained for preoperative and postoperative assessment. Student’s t tests was used to evaluate pre-operative, post-operative, and the last follow-up differences. p≤0.05 was indicated that the difference was statistically significant. Results： Totally 18 patients were identified for inclusion in this study. 100% of the patients achieved union at the last follow-up. The average age was 27.22 (17-49). The time from injury to surgery was 12.94 (1-48) months, with the median of 41.86 weeks. The average healing time from surgery was 15.27 (10-27)weeks. The time of follow-up was 49.5 (4-119)months. We evaluated the ideal range of scaphotomy by comparing scaphoid length and postoperative scaphoid shortening rate. The rate of scaphoid shortening was 4.288% (0.40%-9.05%). There were statistically significant differences among the scapholunate angle, the radiolunate angle, the mean scapholunate interval, the post-op Quick DASH, the VAS pain score, the Grip strength and the range of motion before, after surgery and at the last follow-up all had significant improvement(p＜0.05). There were no difference in time of union bewteen different patient ages, different fracture locations, smoking or not, alcohol consumption or not , or time of treatment. Conclusions： Our method have equal or superior union rate comparing to other techniques in the literature. This paper highlighted the keys to use this method successfully.