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Scaphoid Length Loss Following Nonunion Is Associated with Dorsal Intercalated Segment Instability.
Anne Eva J Bulstra1,2, Alex Jug Vidovic1, Job N Doornberg1,2
1Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia.
Journal of Wrist Surgery
|October 16, 2023
Summary
Scaphoid length loss, not fracture location, significantly correlates with dorsal intercalated segment instability (DISI) in scaphoid nonunions. Restoring scaphoid height is crucial during reconstruction for improved outcomes.
Area of Science:
- Orthopedic surgery
- Hand and wrist surgery
- Radiology
Background:
- Dorsal intercalated segment instability (DISI) in scaphoid nonunions is often linked to fracture location.
- This study investigates alternative factors contributing to DISI in scaphoid nonunions.
Purpose of the Study:
- To determine the correlation between scaphoid length loss, fracture location, and nonunion type with DISI deformity.
- To evaluate the radiolunate (RL) angle as a measure of DISI in scaphoid nonunion patients.
Main Methods:
- Retrospective analysis of 27 CT-confirmed scaphoid nonunions (>6 months).
- Scaphoid length loss quantified by height-to-length (H/L) ratio.
- Fracture location and nonunion type (Herbert classification) were assessed.
Main Results:
- Scaphoid length loss (H/L ratio) was the sole significant factor correlated with DISI (RL angle).
- Increased scaphoid length loss correlated with a larger RL angle.
- No significant difference in RL angle was found based on fracture location or nonunion type.
Conclusions:
- Scaphoid length loss, rather than fracture location, is the primary correlate of DISI deformity in scaphoid nonunions.
- Restoring scaphoid height is essential in surgical reconstruction planning for scaphoid nonunions.
