Scaphoid nonunion treated by open reduction, anterior inlay bone grafting, and Kirschner-wire fixation

Abstract

Forty-three patients with ununited fractures of the scaphoid were treated by open reduction, anterior inlay bone grafting and Kirschner wire fixation. All but one achieved bone union. The one failure was successfully treated with a second anterior inlay bone grafting procedure. The average period of cast immobilization was 7 weeks. The presence of an unstable nonunion did not adversely affect the results. In cases with carpal instability, we used a longer corticocancellous graft to restore a more normal alignment of the scaphoid by opening up the volar cortex. Preoperatively, carpal instability was present in 25 patients. In these cases, carpal alignment demonstrated by the radiolunate and scapholunate angle was improved significantly after surgery: the radiolunate angle from 15 degrees before surgery to 2 degrees after surgery, and the scapholunate angle from 67 degrees to 54 degrees, respectively. Pain, restricted motion of the wrist, and the grip strength were improved after surgery.

The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions

“…Chen et al [ 27 ] reported a 100% union rate in 39 patients treated for scaphoid nonunion with corticocancellous bone graft and multiple, divergent K-wire fixation. Takami et al [ 28 ] reported a 98% union rate in 43 patients using corticocancellous bone graft combined with K-wire fixation. We achieved the bone union with 1.2 mm K-wires in 26 patients.…”

The Vascularity and Osteogenesis of a Vascularized Flap for the Treatment of Scaphoid Nonunion: The Pedicle Volar Distal Radial Periosteal Flap

“…Fixation methods described include K-wires 5,12,15,32,40,43 to maximize the cross-sectional bone area for healing and technical ease, centrally placed screws 30,31 for maximal stability, 2 screws 16 to decrease torsional instability, 1 screw and a derotation pin, 39 1 screw and an external fixator to limit wrist motion to a greater degree than possible with a cast, 26 and a volar plate. 11 Graft methods that have been reported include cancellous bone chips, 6,32,41 nonvascularized corticocancellous wedges, 36 vascular pedicle grafts such as the 1-2 intercompartmental graft, 26,31,43 volar ulnar distal radial grafts, 8 first and second metacarpal artery grafts, 2,25,28,42 dorsal capsular grafts, 33 and free medial femoral 12,40 and free iliac crest grafts. 15 Given the wide variety of treatment options available, it is challenging to assign an incremental healing benefit to each of the possible steps in the treatment of scaphoid nonunion.…”

Healing of a Scaphoid Nonunion Using Human Bone Morphogenetic Protein

“…Traditionally scaphoid nonunions have been treated with nonvascularized bone grafts with or without additional internal fixation, with union rates ranging between 70% and 100%. [43][44][45][46][47][48] More recently vascularized bone grafts have been described to treat established nonunions after failure of conventional attempts using nonvascularized bone grafts and nonunions of the poorly vascularized proximal third of the scaphoid. 49 -54 It is impossible to prove unequivocally that the osteoinductive properties of BMP were directly responsible for the bony healing of this proximal pole nonunion.…”