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Scaphoid Malunion: Incidence, Predictors, and Outcomes.

Jill Putnam1, Kayla Pfaff2, Jeffrey Yao1

  • 1Stanford University School of Medicine, Redwood City, California.

Journal of Wrist Surgery
|January 16, 2023
PubMed
Summary

Scaphoid malunion, defined by specific angles and ratios, occurs in 15% of scaphoid injuries. Despite previous concerns, malunited scaphoids show similar functional outcomes regarding pain, range of motion, and need for secondary surgery compared to non-malunited fractures.

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Quality Measures Addressing Disparities to Improve Outcomes in Hand Surgery.

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Patient Perceptions Regarding Opioid Use: Factors Influencing Participation in a Postoperative Pain Management Randomized Controlled Trial after Carpometacarpal Arthroplasty.

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Trauma Surgery

Background:

  • Scaphoid malunion is infrequently reported, with prior literature suggesting potential for carpal height loss and degenerative changes.
  • The prevalence of asymptomatic scaphoid malunions remains largely undetermined.
  • This study investigates predictors and functional outcomes of scaphoid malunion.

Purpose of the Study:

  • To identify predictors associated with scaphoid malunion.
  • To evaluate the functional outcomes of scaphoid malunion.
  • To determine if malunited scaphoid fractures lead to worse patient-reported outcomes or functional deficits.

Main Methods:

  • Retrospective review of 355 patients (2000-2020) treated for scaphoid fractures or nonunion.
  • Malunion defined by lateral intrascaphoid angle (LISA) >45° and height-to-length ratio (HLR) >60.
Keywords:
SNACfracturefunctionmalunionpainscaphoidsurgeryunion

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  • Evaluation of pain scores, range of motion (ROM), and secondary surgery rates.

    • Main Results:

    • 15% (55/355) of scaphoid injuries met the criteria for malunion.
    • Malunion was more common in nonunion cases and proximal pole fractures compared to acute fractures and waist fractures, respectively.
    • Malunited scaphoids showed no significant differences in pain, ROM, or secondary surgery rates compared to non-malunited scaphoids.

    Conclusions:

    • Scaphoid injuries healing in malunion demonstrate comparable functional outcomes to those that heal without malunion.
    • This study suggests that scaphoid malunions do not inherently lead to worse functional outcomes, challenging previous assumptions.
    • The findings indicate that malunion, defined by specific radiographic parameters, may not be a significant predictor of poor functional results in scaphoid fractures.