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PLATE USING CANCELLOUS GRAFT VERSUS SCREW USING CANCELLOUS CORTICAL GRAFT IN THE TREATMENT OF SCAPHOID PSEUDARTHROSIS
Erick Yoshio Wataya1, Antonio Isidoro Sousa1, Thales Augusto Tomé1
1Universidade de Sao Paulo, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia (IOT HCFMUSP), Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil.
Acta Ortopedica Brasileira
|September 17, 2025
Summary
Plate fixation with cancellous graft showed superior outcomes for scaphoid pseudarthrosis compared to screw fixation with corticocancellous graft, improving wrist functionality and range of motion.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Musculoskeletal Research
Background:
- Scaphoid pseudarthrosis, a nonunion of the scaphoid bone, can lead to carpal instability and functional deficits.
- Treatment options aim to achieve bone consolidation, restore carpal alignment, and improve limb function.
Purpose of the Study:
- To compare the efficacy of screw fixation with corticocancellous graft versus plate fixation with cancellous graft in treating scaphoid pseudarthrosis.
- To evaluate differences in bone consolidation, carpal stability, and functional recovery between the two surgical techniques.
Main Methods:
- A non-randomized retrospective cohort study included 19 patients with scaphoid pseudarthrosis.
- Patients were divided into two groups: Group A (screw and corticocancellous graft, n=9) and Group B (plate and cancellous graft, n=10).
- Outcomes including range of motion, grip strength, pinch strength, DASH, MAYO wrist score, carpal angles, and consolidation rate were assessed preoperatively and 12 weeks postoperatively.
Main Results:
- Group B demonstrated a 100% consolidation rate compared to 90% in Group A, though Group B had a longer consolidation time (9.7 weeks).
- Group B showed superior improvement in range of motion, pinch strength, grip strength, and MAYO wrist score.
- Both groups achieved pain reduction and scapholunate angle correction, but Group A experienced loss of radial and ulnar deviation.
Conclusions:
- Plate fixation with cancellous graft (Group B) leads to better functional recovery, including range of motion and strength, compared to screw fixation with corticocancellous graft (Group A).
- While both methods achieve consolidation and correct carpal angles, the plate technique offers superior functional outcomes for scaphoid nonunion.
- This study provides Level of Evidence III support for the effectiveness of plate fixation in scaphoid pseudarthrosis treatment.
