Compression screw fixation without bone grafting for scaphoid fibrous nonunion

Jeremy Somerson, Daniel J. Fletcher, Ramesh C. Srinivasan, David P. Green

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Purpose: Bone graft is often recommended as an adjuvant for treatment of scaphoid nonunions. However, recent literature has suggested that fibrous nonunion may be suited to treatment with rigid fixation without bone grafting. This work reported on outcomes of compression screw fixation for established scaphoid fibrous nonunions without bone graft. Methods: Fourteen patients underwent surgical compression screw fixation without bone grafting of scaphoid fibrous nonunion between January 1, 2000, and December 31, 2012, with minimum follow-up until the time of clinical and radiographic healing. Fibrous nonunion of the scaphoid was defined as a scaphoid fracture with all of the following features: (1) persistent tenderness, (2) incomplete trabecular bridging on three X-ray views, (3) injury that had occurred at a minimum of 6 months prior to surgery, and (4) identification of fibrous union at the time of surgery. Outcomes were assessed with range of motion assessment, Disability of the Arm, Shoulder and Hand (DASH) scores, and plain radiographs. Results: Twelve of the 14 patients healed successfully, while two patients required secondary vascularized bone grafting. Both unhealed patients sustained proximal pole fractures and had a duration of ≥1 year from injury to surgery. Average time to healing was 4.4 ± 2.0 months. Average flexion was 73 ± 22° and average extension was 66 ± 22° postoperatively. Average grip strength was 90 ± 25 lbs on the operative side. Mean postoperative pain score was 1.4 (range, 0 to 7). Mean postoperative DASH score was 10.2 (range, 0 to 52). Increasing age and an interval from injury to surgery of >1 year correlated with worse DASH and pain scores. Conclusions: Patients with fibrous scaphoid nonunion demonstrated good results with rigid fixation without bone grafting. Increasing age and >1-year interval between injury and surgery resulted in lower self-assessed outcomes. Level of Evidence: Therapeutic Level IV, retrospective case series

Original languageEnglish (US)
Pages (from-to)450-453
Number of pages4
JournalHand
Volume10
Issue number3
DOIs
StatePublished - Feb 18 2015
Externally publishedYes

Fingerprint

Bone Transplantation
Arm
Hand
Wounds and Injuries
Transplants
Bone and Bones
Shoulder Pain
Hand Strength
Postoperative Pain
Articular Range of Motion
Therapeutics
X-Rays

Keywords

  • Compression screw
  • Nonunion
  • Scaphoid

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Compression screw fixation without bone grafting for scaphoid fibrous nonunion. / Somerson, Jeremy; Fletcher, Daniel J.; Srinivasan, Ramesh C.; Green, David P.

In: Hand, Vol. 10, No. 3, 18.02.2015, p. 450-453.

Research output: Contribution to journalArticle

Somerson, Jeremy ; Fletcher, Daniel J. ; Srinivasan, Ramesh C. ; Green, David P. / Compression screw fixation without bone grafting for scaphoid fibrous nonunion. In: Hand. 2015 ; Vol. 10, No. 3. pp. 450-453.
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