gms | German Medical Science

Objectives/Interrogation: The primary aim of this study was to identify the rate of osteoarthritis in scaphoid fracture non-union.The secondary objectives were to investigate whether the incidence of degenerative changes correlates with the duration of non-union(interval) and the site of fracture, and to identify the variables that influence the primary outcome.

Methods: We conducted a retrospective review of 273 consecutive cases with scaphoid fracture non-union presenting to our hand surgery unit from 2007- 2016. Data included patient demographics, the duration of non-union (interval), anatomical location of fracture (distal, middle, and proximal), anatomical area of scaphoid non-union advanced collapse [SNAC areas 1-3], and the presence of dorsal intercalated segmental deformity (DISI). Overall health-related quality of life were assessed using EuroQol five-dimensional questionnaire(EQ-5D). Data was retrieved from case notes, Patient Archiving and Communication System (PACS), postal and telephone follow-up using a designated case report form. Patients were divided into two groups (SNAC vs. Non- SNAC). Group differences were analysed by the Mann-Whitney U test and association between scales with Pearson's correlations. A two-sided p-value of <0.05 was assumed as significant.

Results and Conclusions: We identified 273 cases with scaphoid fracture non-union confirmed on CT scans (n=250) and plain radiographs (n=23). The subjects consisted of 33 males and 240 females with the mean age of 34.3 years (SD,13.2). Degenerative changes occurred in 49% (n=135) of non-unions (SNAC group), and 51% (n=141) had no degenerative changes (non-SNAC group). In overall, the average interval was 3.1 years (range, 0-45 years) in those with known date of initial injury (n= 221). The fracture location in SNAC group included 3.3% of distal 20%, 41 % of middle 60% (distal to ridge), 29% of middle 60% (at ridge), 88 % of middle 60% (proximal to ridge), and 100% of proximal 20% fracture non-unions. Of these, 67% had SNAC 1,14% with SNAC 2, and 21% presented with SNAC 3. The mean interval in the SNAC 1, 2, and 3 were 4.3, 4.9, and 5.5 years, respectively. An overall incidence of DISI deformity of the wrist was 86 %. The average summary index between SNAC and non-SNAC groups was 0.803 and 0.819, respectively. Our results demonstrate that advanced osteoarthritis was seen more in the proximal fracture non-unions (P<0.05). There was no clear correlation between the interval and the progression of osteoarthritis. SNAC occurred in fractures aged 4 years or older.