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Proximal scaphoid nonunion-osteosynthesis
1St. Lukes Hospital Hand Unit, Sydney/Australia.
Handchirurgie, Mikrochirurgie, Plastische Chirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Handchirurgie : Organ Der Deutschsprachigen Arbeitsgemeinschaft Fur Mikrochirurgie Der Peripheren Nerven Und Gefasse : Organ Der V
|July 27, 1999
Summary
Simple osteosynthesis using retrograde screw fixation effectively treats symptomatic proximal pole scaphoid nonunion. This approach preserves bone stock and vascularity, leading to rapid symptom improvement and excellent wrist function in most patients.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Traumatology
Background:
- Proximal pole scaphoid fractures have high rates of nonunion and avascular necrosis.
- Treatment for these fractures is controversial due to poor prognosis.
Purpose of the Study:
- To evaluate the efficacy of simple osteosynthesis with retrograde screw fixation for symptomatic proximal pole scaphoid nonunion.
- To assess functional outcomes and union rates in patients treated with this technique.
Main Methods:
- 102 patients with symptomatic proximal pole scaphoid nonunion underwent retrograde screw fixation via a direct dorsal approach.
- Minimal fracture preparation and bone grafting were employed to preserve bone stock and vascularity.
- No postoperative splinting was utilized.
Main Results:
- At an average 34-month follow-up of 69 patients, 85% were asymptomatic with excellent wrist function.
- Radiological union was observed in 50% of cases, often slow (3-36 months).
- Incomplete union did not compromise fracture stability or fixation, preserving wrist function.
Conclusions:
- Stable internal fixation of proximal pole scaphoid nonunion provides rapid symptomatic improvement and preserves wrist function.
- This technique offers a favorable long-term prognosis, even with incomplete radiological union, by maintaining scaphoid integrity.