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

Abstract

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3–10) preoperatively to 1.59 (range, 0–3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.

Clinical and Epidemiological Features Among Patients with Wrist Arthroscopy Surgery: A Hospital‐based Study in China

“…Carpal trauma (carpal bone fractures and/or carpal ligament injuries) accounted for 23.1% of total cases. It has been reported that the procedures traditionally conducted by open surgery for the carpal trauma could be replaced by arthroscopic procedures 5,13 . With the development of wrist arthroscopy techniques, more patients with carpal trauma will be treated with more minimally invasive arthroscopic procedures 20 .…”

“…Osseous procedures include partial bone resections in scaphotrapeziotrapezoid (STT) and ulnocarpal or ulnostyloid impaction syndrome 7,11 . The method has also gained wider acceptance in more sophisticated procedures as assisting reduction of intra-articular distal radius fractures 12 , or scaphoid fractures, and in posttraumatic sequelae 13,14 . Arthroscopically assisted osteotomy in intra-articular distal radius malunions, treatment of scaphoid nonunions and arthroscopic arthrolysis has been described 5,15 .…”

“…Some traditional open procedures could be replaced by wrist arthroscopy procedures. For example, arthroscopic bone grafting for scaphoid nonunion could be performed in most of the cases, avoiding massive surgical trauma to the soft tissue 5,13 . More complex conditions, such as perilunate dislocations, could be treated in a minimally invasive manner by arthroscopic-assisted procedures as well 20 .…”

Vascularized bone graft and scapholunate fixation for proximal scaphoid nonunion: a case report

“…Arthroscopic debridement and bone grafting is another method to treat scaphoid nonunion, even when there is ischemic change, and the results have been reported to be good [12]. With the more limited violation of the surrounding soft tissue, it would be possible to maintain more circulation to the scaphoid.…”

Wrist Function Recovery Course in Patients with Scaphoid Nonunion Treated with Combined Volar Bone Grafting and a Dorsal Antegrade Headless Screw

“…A literature review regarding the wrist functional recovery course after scaphoid nonunion surgery is presented in Table 4. (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The union rates ranged from 84.…”