Article
Description and outcomes of surgical technique for treatment of scaphoid nonunion with olecranon bone graft
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Authors
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Paulo Randal Pires
- Hospital Madre Teresa, Belo Horizonte, Brazil
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Paulo Randal Pires Júnior
- Hospital Madre Teresa, Belo Horizonte, Brazil
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Marcella Rodrigues Costa
- Hospital Madre Teresa, Belo Horizonte, Brazil
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Gustavo Pacheco Martins Ferreira
- Hospital Maria Amélia Lins, Belo Horizonte, Brazil
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Daniel Barbosa Regazzi
- Hospital Maria Amélia Lins, Belo Horizonte, Brazil
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The best treatment for scaphoid nonunion remains controversial and this paper describes a surgical technique for the treatment of nonunion of the scaphoid with the rate of consolidation based on radiographs. The aim of this study is to demonstrate a less morbid procedure with good results when compared to several techniques described in the literature.
Methods: A group of 21 patients with the diagnosis of nonunion of the scaphoid was submitted to surgical treatment at an orthopaedic service from December 2013 to December 2017, however six had to be excluded from the research. It was obtained than, 15 cases who had the complete follow-up and medical records. The surgical technique used a palmar approach to access the scaphoid and clean the nonunion focus. An osteotome or a tweezers was kept in focus to maintain bone height, length and correct alignment. The fixation of the scaphoid with hadless screw was made prior to graft placement, in contradistinction to literate techniques. Subsequently, bone graft obtained from olecranon was positioned in the nonunion space. The wrist was immobilized with short splint postoperatively for 4 weeks, when rehabilitation was instituted. Patient's radiographs were analyzed at all appointments until radiographic heal of the scaphoid were seen.
Results and Conclusions: All 15 patients were male such as literature data. The site of involvement was the middle third of the scaphoid associated with reabsorption larger than 5mm, subchondral cysts and malalignment. The mean age found was 35.2 years (18-53) and the most affected hand was dominant (60%). The average time to consolidation was 3.4 months (2-5) and all patients demonstrated consolidation on the radiographs in the postoperative follow-up. There was no need to use computed tomography or other image exams to diagnose the consolidation.
Recent techniques show high rates of consolidation, around 88% to 92% despite the type of bone graft (vascularized or non-vascularized). Some authors obtained consolidation with an average time of 6.2 weeks using vascularized graft, and others even 10.2 weeks. This paper shows 100% of heal using a non-vascularized ulna graft, with an average time of 3,4 months.
The treatment for scaphoid nonunion remains a challenge and this study brings a good option for the surgical technique with encouraging results when compared to techniques established in the literature.
