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Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion
Philip M J Schormans1, Peter R G Brink1, Martijn Poeze1
1Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Journal of Wrist Surgery
|February 1, 2018
Summary
Volar angular stable miniplate fixation with bone grafting successfully treated chronic scaphoid nonunion in 90% of patients. This method is effective even for long-standing cases and those with prior surgeries, aiding fracture healing.
Area of Science:
- Orthopedic Surgery
- Hand and Wrist Surgery
- Trauma Surgery
Background:
- Scaphoid nonunion occurs in 5-15% of fractures and poses treatment challenges.
- Healing scaphoid nonunion is crucial to prevent advanced collapse and osteoarthritis.
- Chronic scaphoid nonunion requires effective surgical solutions.
Purpose of the Study:
- To assess the feasibility of treating scaphoid nonunion with volar angular stable miniplate fixation and bone grafting.
- To evaluate the technique's success in patients with long-standing nonunion or previous surgical interventions.
- To hypothesize the technique's efficacy in achieving scaphoid union.
Main Methods:
- A prospective cohort study involving 21 patients with scaphoid nonunion.
- Radiological assessment of nonunion healing via CT scans at 3-month intervals.
- Functional outcomes measured by grip strength, range of motion, and PRWHE scores.
Main Results:
- 90% of patients (19/21) achieved radiological healing of the scaphoid nonunion.
- Functional outcomes showed a significant decrease in PRWHE scores by 34 points.
- Healing was achieved irrespective of nonunion duration (6-183 months) or prior surgery history.
Conclusions:
- Volar angular stable miniplate fixation with bone grafting is a successful treatment for chronic unstable scaphoid nonunion.
- The technique demonstrates efficacy in complex cases, including those with long-term nonunion and previous surgeries.
- Rotational interfragmentary stability may be a key factor in successful unstable scaphoid nonunion treatment.
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