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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Outcomes of local bone graft and fixation of proximal pole scaphoid non-unions

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  • presenting/speaker Chaitanya Mudgal - Massachusetts General Hospital, Boston, United States
  • Kristin Shoji - Massachusetts General Hospital, Boston, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1556

doi: 10.3205/19ifssh1207, urn:nbn:de:0183-19ifssh12074

Published: February 6, 2020

© 2020 Mudgal et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Scaphoid fractures often present in delayed fashion as they are frequently perceived as minor wrist injuries. Proximal pole scaphoid fractures are thought to be at increased risk of nonunion due to the tenuous blood supply about this location. It is generally agreed upon that scaphoid waist nonunions are treated with screw fixation and bone graft; however, there are many proposed treatment options for proximal pole scaphoid fractures, and current literature has focused prevalently on vascularized bone grafts. The purpose of this study was to review a single surgeon's experience with proximal pole scaphoid nonunions that underwent surgical fixation with autogenous bone graft and screw fixation.

Methods: After obtaining IRB approval the EMR of one tertiary care center was queried for patients with the diagnosis of "proximal pole scaphoid fractures" over an 11-year period from 2006 through 2017 that underwent surgical fixation by a single surgeon (CSM). Fifteen patients met initial query criteria; upon review of records, 4 patients were excluded due to the acute nature of the fracture and 1 was excluded as surgical fixation included a vascularized bone graft.

Results and Conclusions: The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Six patients underwent a pre-operative magnetic resonance imaging (MRI) and two patients were found to have signs of dysvascularity of the proximal pole on MRI. Volumetric measurements of the scaphoid fractures on CT were performed: average total volume of the fracture fragment was 2.4 ± 0.48 cm3 and the average volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Eight patients underwent local bone grafting, and bone graft was inserted at the site of fracture in 7 patients and in the screw track in 1 patient. Union was documented by postoperative CT scan; seven showed signs of union at the time CT was obtained and three demonstrated partial union. None required additional procedures and there were no complications.

Proximal pole scaphoid fractures are thought to be at an increased risk of nonunion due to the tenuous blood supply. Current literature includes many proposed treatment options for proximal pole scaphoid fractures. The volume of the proximal pole fragment does not seem to correlate with increased risk of nonunion. Proximal pole scaphoid nonunions treated with surgical fixation and autogenous localized bone graft go on to union.