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Cartilage Cap in Scaphoid Nonunions: An Indication of Stability and Biology?
Frank Vazquez1, Joanne Y Zhou1, Kier M Blevins1
1Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA.
Purpose:
Scaphoid nonunion management is controversial and is dependent upon many factors without a clear algorithm. Traditionally, open approaches involved corticocancellous, vascularized, or nonvascularized structural bone grafting with internal fixation. Recent arthroscopic techniques have improved the ability to assess the stability of fractures and the need for bone grafting while preserving blood supply. We present our experience with arthroscopic-assisted scaphoid nonunion repairs that were discovered to have an intact cartilage cap at the nonunion site and thus were treated with screw fixation alone.
Methods:
A retrospective review of patients diagnosed with scaphoid nonunion (defined as the lack of union on computed tomography at 6 months postinjury or no change on interval computed tomography scans at least 3 months apart) was performed. Nine patients-noted to have an intact cartilage cap, defined as continuous cartilage as viewed from the midcarpal and radiocarpal portals, without mobility at the fracture site on probing-were included. All underwent percutaneous screw fixation without fracture debridement. Time to union, range of motion, and patient-reported outcome measures were collected retrospectively.
Results:
Nine patients aged 16-33 years, with a median follow-up of 35 months (range: 2-74), were included. The mean radiographic displacement was 2 mm, and no fractures had a humpback deformity or dorsal intercalated segmental instability. There was a 100% union rate. At the final follow-up, patient-reported outcome measures demonstrated overall improvement across the cohort. No complications were observed.
Conclusions:
Scaphoid nonunions with minimal displacement, maintained mechanical malignment of the carpus, and an intact cartilage cap represent a stable pattern that can be treated by restoring mechanical stability. Thus, if a cartilage cap is found to be intact, arthroscopic-assisted percutaneous screw fixation results in bony union, favorable outcomes, with minimal pain and excellent patient-reported outcomes.
Type Of Study/Level Of Evidence:
Therapeutic V.
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