Article
Factors affecting union rate when treating scaphoid nonunion using non-vascularized bone grafting with internal fixation: preliminary report
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Authors
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Jin Young Kim
- Dongguk University Ilsan Hospital, Goyang, South Korea
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Sang lim Lee
- Sanggye Baek Hospital, Seoul, South Korea
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: We attempted to investigate whether the union rate changed according to different techniques of non-vascularized bone grafting and internal fixation, when treating unstable scaphoid nonunion at waist.
Methods: 39 patients with unstable scaphoid nonunion at waist were involved. We divided the patients into three groups, according to bone grafting and fixation methods: Cancellous bone grafting with K-wire fixation, cortico-cancellous bone grafting with K-wire fixation and cortico-cancellous bone grafting with headless screw fixation. We longitudinally observed how many patients in each group had bony union. Time to surgery, type of nonunion, time to union and number of union failure were also checked for comparison between the groups. The failure cases were presented for analysis.
Results and Conclusions: There were 37 men and 2 women with mean age 28.7 years (range, 18-56). Mean follow-up period is 26.3 (range 24- 53) months. 13 patients were treated by cancellous bone grafting with K-wire fixation, 12 patients by cortico-cancellous bone grafting with K-wire fixation and 13 patients by cortico-cancellous bone grafting with headless screw. Overall union rate was 86.8% (33/38). Union rate was 100% in cancellous bone grafting with K-wire fixation group, 83% in cortico-cancellous bone grafting with K-wire fixation group and 77% in cortico-cancellous bone grafting with headless screw group. There was no difference in time to surgery, nonunion type and time to union between the groups. All the failure cases were sclerotic scaphoid nonunion and had DISI deformity.
Cancellous bone grafting seems to be more helpful to achieve union of unstable scaphoid nonunion at waist than cortico-cancellous bone grafting, regardless of the type of unstable scaphoid nonunion. The method of internal fixation seems to have had little impact on union rate of bone grafting for scaphoid nonunion. However, the failure of union was most commonly encountered when sclerotic nonunion with DISI deformity was treated by cortico-cancellous bone grafting + headless screw fixation. Based on this study, further studies regarding the advantages and disadvantages of each bone grafting and internal fixation methods should be performed in a larger number of patients.
