Clinical Result of Operative Treatment for Scaphoid Non-Union in the Skeletally Immature: Percutaneous Versus Open Procedure

Abstract

This article is a retrospective study of 13 cases of scaphoid non-union in skeletally immature patients. For the fracture fixation, three cases of stable fibrous union with minimal sclerosis, without deformity or cystic changes were considered for the percutaneous Herbert screw fixation. Ten cases were managed with the open reduction and internal fixation with or without bone grafting. The average union time was 10.5 weeks post-operatively. The average union time was lesser in percutaneous Herbert screw fixation group (nine weeks) than open procedure group (11.5 weeks). All cases achieved union without any supplemental procedures. According to Cooney's clinical scoring, 12 cases were rated excellent result and one good result. The percutaneous Herbert screw fixation for scaphoid non-union in skeletally immature patients can be a good treatment option when it is fibrous union with no deformity.

Pseudarthrosis of the Scaphoid in Immature Skeletons

“…The natural history of pseudarthrosis of the scaphoid in immature skeletons is unknown. The biomechanical alterations seen in the wrists of adults have not yet been reported in children 8 , 9 , 10 . A differential diagnosis need to be made with bipartite scaphoid, which is usually bilateral, asymptomatic and unrelated to previous trauma.…”

Pseudoartrose do escafoide em esqueleto imaturo

“…This classification provides a guide for surgeons regarding the type of treatment to use (1,8,9,12) (Figure 1). (12) .…”

“…They may also be complemented by specific views for the scaphoid (8,9,13) . Masquijo and Willis (1) reported that the presence of sclerosis, cystic formations and bone reabsorption define pseudarthrosis on radiographic images.…”

“…Jeon et al (8,9) recommended percutaneous fixation with a Herbert screw for cases of stable pseudarthrosis with minimal bone reabsorption and without deformities. Slade et al (32) reported that in selected cases of fibrous union or cases of non-union with minimal sclerosis that had the biological capability to achieve consolidation but lacked mechanical stability for cure to be attained, percutaneous fixation with a Herbert screw would be enough for consolidation.…”

“…The natural history of pseudarthrosis of the scaphoid in immature skeletons is unknown. The biomechanical alterations seen in the wrists of adults have not yet been reported in children (8)(9)(10) . A differential diagnosis need to be made with bipartite scaphoid, which is usually bilateral, asymptomatic and unrelated to previous trauma.…”