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HOME > J Musculoskelet Trauma > Volume 23(1); 2010 > Article
Original Article
Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
Eun Sun Moon, M.D., Myung Sun Kim, M.D., Il Kyu Kong, M.D., Min Sun Choi, M.D.
Journal of the Korean Fracture Society 2010;23(1):69-75.
DOI: https://doi.org/10.12671/jkfs.2010.23.1.69
Published online: July 15, 2010

Department of Orthopedic Surgery, Chonnam National University School of Medicine, Gwangju, Korea.

Address reprint requests to: Il Kyu Kong, M.D. Department of Orthopedic Surgery, Chonnam National University School of Medicine, 8, Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-227-1640, Fax: 82-62-225-7794, kongilkyu@gmail.com
• Received: July 22, 2009   • Revised: September 30, 2009   • Accepted: December 6, 2009

Copyright © 2010 The Korean Fracture Society

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  • Purpose
    To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors.
  • Materials and Methods
    Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated.
  • Results
    Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery.
  • Conclusion
    Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.
  • Key words: Scaphoid nonunion, Internal fixation, Bone graft
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Fig. 1
Fragment ratio. Horizontal lines were drawn to define the extent of the fragment. The middle of the fragment was identified and a midline was drawn connecting the two horizontal lines. The lengths of these lines (P, D) were measured to determine the fragment size (P: Proximal fragment, D: Distal fragment).
jkfs-23-69-g001.jpg
Fig. 2
(A) Radiographs of 22 years old male shows slightly proximally located nonunion of scaphoid.
(B) Serial follow-up radiographs and (C) computer tomography at postoperative 8 month show failure of healing process.
jkfs-23-69-g002.jpg
Fig. 3
(A) Radiographs of 47 years old male shows proximally located nonunion of scaphoid.
(B) Computer tomography demonstrates cystic change of nonunion site and degenerative change of radial styloid and radioscaphoid joint.
(C) Serial follow-up radiographs show failure of healing process at 4 months postoperatively.
jkfs-23-69-g003.jpg
Fig. 4
(A) Radiographs of 16 years old female shows suspicious finding of distally located nonunion of scaphoid.
(B) Computer tomography demonstrates cystic change of nonunion site.
(C) Serial follow-up radiographs show complete union at about 12 weeks after surgery.
jkfs-23-69-g004.jpg
Table 1
Summary of cases
jkfs-23-69-i001.jpg

OV: Openvolar approach, OD: Open dorsal approach, P: Percutaneous approach, *p<0.05, †p>0.05.

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        Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
        J Korean Fract Soc. 2010;23(1):69-75.   Published online January 31, 2010
        DOI: https://doi.org/10.12671/jkfs.2010.23.1.69
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      Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
      Image Image Image Image
      Fig. 1 Fragment ratio. Horizontal lines were drawn to define the extent of the fragment. The middle of the fragment was identified and a midline was drawn connecting the two horizontal lines. The lengths of these lines (P, D) were measured to determine the fragment size (P: Proximal fragment, D: Distal fragment).
      Fig. 2 (A) Radiographs of 22 years old male shows slightly proximally located nonunion of scaphoid. (B) Serial follow-up radiographs and (C) computer tomography at postoperative 8 month show failure of healing process.
      Fig. 3 (A) Radiographs of 47 years old male shows proximally located nonunion of scaphoid. (B) Computer tomography demonstrates cystic change of nonunion site and degenerative change of radial styloid and radioscaphoid joint. (C) Serial follow-up radiographs show failure of healing process at 4 months postoperatively.
      Fig. 4 (A) Radiographs of 16 years old female shows suspicious finding of distally located nonunion of scaphoid. (B) Computer tomography demonstrates cystic change of nonunion site. (C) Serial follow-up radiographs show complete union at about 12 weeks after surgery.

      Fig. 1

      Fig. 2

      Fig. 3

      Fig. 4

      Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft

      Summary of cases

      OV: Openvolar approach, OD: Open dorsal approach, P: Percutaneous approach, *p<0.05, †p>0.05.
      Table 1 Summary of cases

      OV: Openvolar approach, OD: Open dorsal approach, P: Percutaneous approach, *p<0.05, †p>0.05.

      Table 1

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