Arthroscopic Treatment of Scaphoid Non-union leads to Union and Improved Outcomes

Pathum Thani, Thailand:There has been increasing interest in minimally invasive procedures for scaphoid nonunion via arthroscopic bone grafting and fixation, aiming to minimize devitalization of the scaphoid fragments. The factors that predispose to scaphoid nonunion are displaced scaphoid fracture, proximal-pole fracture, associated carpal instability, and delay of appropriate treatment.

According to Slade and Dodds scaphoid non union recommendation, grades I to III require rigid fixation whereas cases with substantial bone loss or a large defect (grades IV and V) require cancellous bone grafting with rigid fixation; cases with marked bone resorption with carpal collapse deformity (grade VI) may need corticocancellous bone grafting with rigid fixation.

T. WAITAYAWINYU et al conducted a study to evaluate the outcomes of arthroscopic treatment of scaphoid non-union using olecranon bone graft and screw fixation and to analyze the outcomes in accordance with variations in the chronicity, location, and severity of non-union.

Between March 2012 and December 2020, patients with diagnoses of scaphoid delayed non-union and non-union with substantial bone resorption (Slade and Dodds grade IV-VI) underwent arthroscopic-assisted olecranon bone graft and screw fixation. Preoperative and postoperative measurements included the visual analog scale score for pain; range of motion; grip strength; the Modified Mayo Wrist Score; the Disabilities of the Arm, Shoulder and Hand (DASH) score; and the minimal clinically important difference for the DASH score. Union rate and duration were also evaluated. The outcomes between groups of patients with different conditions were analyzed.

Results:

• Twenty-two patients were included.

• The average follow-up period was 32.5 months.

• The visual analog scale pain score, range of motion, grip strength, Modified Mayo Wrist Score, and DASH score were significantly improved after surgery (P < .001).

• The minimal clinically important difference threshold for the DASH score was reached by 100% of patients.

• At final follow-up, all patients had united scaphoid with no complications.

• The average time to union was 15.3 weeks.

• Group analysis showed significant improvements in mean grip strength between patients with delayed union (3-6 months) and those with chronic non-union (> 1 year) (17.75 kg vs 12.25 kg, P = .032), between grade IV non-union and grade V non-union (14.86 kg vs 10.43 kg, P = .035), and between grade V non-union and grade VI non-union (10.43 kg vs 15.63 kg, P = .013).

• Patients with grade VI non-union achieved union at 17.8 weeks postoperatively, a significantly longer period than that for patients with grade IV non-union (11.4 weeks, P = .014).

The authors concluded that arthroscopic treatment of scaphoid non-union using olecranon bone graft and screw fixation provided satisfactory outcomes regardless of the chronicity, location, and severity of non-union.

Key Words: scaphoid, non-union, arthroscopy, olecranon bone graft, screw fixation

Further reading:

Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes.

Thanapong Waitayawinyu, M.D., Warisara Lertcheewanan, M.D., Chinnakart Boonyasirikool, M.D., and Sunyarn Niempoog, M.D.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 38, No 3 (March), 2022: pp 761-772

https://doi.org/10.1016/j.arthro.2021.09.018