Plate Fixation With Cancellous Graft for Scaphoid Nonunion With Avascular Necrosis

Area of Science:

• Orthopedic surgery
• Hand surgery
• Traumatology

Background:

• Scaphoid nonunion with avascular necrosis (AVN) presents a complex treatment challenge with no universally agreed-upon optimal approach.
• Current treatments often involve vascularized bone grafting, but alternative methods are being explored.

Purpose of the Study:

• To evaluate the efficacy of volar plate fixation combined with autogenous pure cancellous bone grafting for scaphoid nonunion with AVN.
• To test the hypothesis that this technique can yield outcomes comparable to existing methods.

Main Methods:

• Retrospective review of 13 scaphoid nonunion with AVN cases in 12 patients treated with volar plate fixation and cancellous bone grafting.
• Graft harvested from the olecranon and/or distal radius.
• Outcomes assessed via computed tomography (CT) for union, patient-reported scores (pain, disability), grip strength, range of motion, and return to work/sports.

Main Results:

• All 13 scaphoids achieved union, with a mean time to union of 19.5 months post-surgery (range, 12-29 months).
• Mean Disabilities of the Arm, Shoulder, and Hand (DASH) score improved significantly from 30.6 to 17.2.
• 11 of 11 employed patients returned to work, with most returning to full capacity.

Conclusions:

• Volar plate fixation with nonvascularized pure cancellous bone grafting demonstrates excellent union rates for scaphoid nonunion with AVN.
• The procedure leads to good patient-reported outcomes and functional recovery.
• This technique represents a promising option for managing scaphoid nonunion with AVN.