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[Scaphoid malunion].

¹Institut Français de Chirurgie de la Main, Paris, France. psaffar@ifcm.org

Chirurgie De La Main

|July 1, 2008

Summary

Scaphoid malunion, often difficult to diagnose, can cause carpal instability and arthritis. Surgical correction using scaphoid osteotomy and bone grafting offers a successful treatment for symptomatic cases.

Area of Science:

Orthopedic Surgery
Hand Surgery
Radiology

Background:

Scaphoid fractures can lead to malunion, characterized by abnormal healing positions like flexion and shortening, primarily affecting the mid or distal scaphoid.
This malunion can disrupt carpal mechanics, potentially causing osteoarthritis, pain, and reduced motion and strength.
Existing malunions may present with distal fragment rotation or irregular bone contours, both contributing to arthritis development.

Purpose of the Study:

To review the diagnosis and management of symptomatic scaphoid malunion.
To highlight the utility of the intrascaphoid angle of Amadio in quantifying deformity.
To discuss surgical correction techniques for scaphoid malunion.

Main Methods:

Deformity assessment using comparative X-rays, special views, and carpal indices.

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Utilizing specialized software for precise measurement of malunion.

Surgical intervention involving scaphoid osteotomy, trapezoidal bone grafting, and screw fixation.

Main Results:

Scaphoid osteotomy with bone grafting and screw fixation has demonstrated success in literature for correcting malunion.
All reported cases achieved healing after this surgical procedure.
The technique is effective even in previously operated cases for nonunion.

Conclusions:

Symptomatic scaphoid malunion requires precise assessment and can be effectively treated surgically.
Scaphoid osteotomy combined with bone grafting provides a reliable solution for malunion correction.
This surgical approach is a viable option for symptomatic healed scaphoids, including those with prior nonunion treatment.