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Scaphoid Nonunion Volar Plating with Pure Nonvascularized Cancellous Autograft
Paul A Tavakolian1, Nicholas S Adams1, Scott G Edwards1
1Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.
JBJS Essential Surgical Techniques
|July 19, 2021
Summary
Volar plating with cancellous bone grafting effectively treats scaphoid nonunions, achieving high union rates and improving patient function. This surgical technique offers a reliable solution for complex wrist injuries.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Traumatology
Background:
- Scaphoid nonunion surgical treatment has evolved, with volar plating and nonvascularized cancellous autograft emerging as a safe and effective method.
- Traditional fixation methods like headless compression screws may be less suitable for nonunions compared to volar plating.
Purpose of the Study:
- To evaluate the efficacy of volar scaphoid plating with cancellous bone grafting for treating scaphoid nonunions.
- To compare the outcomes of volar plating with other fixation strategies for scaphoid nonunion.
Main Methods:
- Volar plating involves debridement, reduction, and grafting of the nonunion site using autograft from the radius or olecranon.
- A low-profile volar locking plate is applied for fixation, ensuring biomechanical stability.
Main Results:
- Studies show 100% union rates in patients treated with volar plates and pure cancellous autograft, verified by CT scans.
- Significant improvements in functional outcomes, including Disabilities of the Arm, Shoulder and Hand scores and grip strength, were observed.
- The technique demonstrates success even in complex cases, including smokers and those with previous failed surgeries.
Conclusions:
- Volar scaphoid plating with cancellous bone grafting is a reliable and effective treatment for scaphoid nonunions, yielding excellent union rates and functional recovery.
- This technique offers advantages over headless compression screws by providing better stability and preserving the scaphoid's vascularity.
- Careful surgical technique and plate placement are essential to mitigate potential hardware-related complications.
