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. 2011 Nov 8:6:57.
doi: 10.1186/1749-799X-6-57.

The treatment of scaphoid nonunion using the Ilizarov fixator without bone graft, a study of 18 cases

Marko Bumbaširević  1 , Slavko Tomić, Aleksandar Lešić, Vesna Bumbaširević, Zoran Rakočević, Henry D Atkinson
Affiliations

The treatment of scaphoid nonunion using the Ilizarov fixator without bone graft, a study of 18 cases

Marko Bumbaširević et al. J Orthop Surg Res. .

Abstract

Objectives: Evaluating the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft.

Design: A retrospective review of 18 consecutive patients in one centre.

Patients and methods: 18 patients; 17 males; 1 female, with a mean SNU duration of 13.9 months. Patients with carpal instability, humpback deformity, carpal collapse, avascular necrosis or marked degenerative change, were excluded. Following frame application the treatment consisted of three stages: the frame was distracted 1 mm per day until radiographs showed a 2-3 mm opening at the SNU site (mean 10 days); the SNU site was then compressed for 5 days, at a rate of 1 mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the third stage involved immobilization with the Ilizarov fixator for 6 weeks. The technique is detailed herein.

Results: Radiographic (CT) and clinical bony union was achieved in all 18 patients after a mean of 89 days (70-130 days). Mean modified Mayo wrist scores improved from 21 to 86 at a mean follow-up of 37 months (24-72 months), with good/excellent results in 14 patients. All patients returned to their pre-injury occupations and levels of activity at a mean of 117 days. Three patients suffered superficial K-wire infections, which resolved with oral antibiotics.

Conclusions: In these selected patients this technique safely achieved bony union without the need to open the SNU site and without the use of bone graft.

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Figures

Figure 1
Figure 1
Schernberg's scaphoid classification (32) (I-proximal pole, II, III, IV-waist, V-distal and VI-tubercle).
Figure 2
Figure 2
An illustration of the Ilizarov device applied across the wrist: A-proximal ring, B distal ring, 1-Kirschner wire passed through the radius, 2-Kirschner wire passed through the ulna, 3-K wire in the 2nd and 3rd metacarpal bones, 4-K wire in the 4th and 5th metacarpal bone, 5-telescoping rode with 6-hinges joined together forming a complete hinge, 7-nuts and 8-slotted washers for K wire fixation.
Figure 3
Figure 3
An illustration of the Ilizarov device applied across the wrist: A-proximal ring, B distal ring, 1-Kirschner wire passed through the radius, 2-Kirschner wire passed through the ulna, 3-K wire in the 2nd and 3rd metacarpal bones, 4-K wire in the 4th and 5th metacarpal bone, 5-telescoping rode with 6-hinges joined together forming a complete hinge, 7-nuts and 8-slotted washers for K wire fixation.
Figure 4
Figure 4
An illustration of the Ilizarov device applied across the wrist: A-proximal ring, B distal ring, 1-Kirschner wire passed through the radius, 2-Kirschner wire passed through the ulna, 3-K wire in the 2nd and 3rd metacarpal bones, 4-K wire in the 4th and 5th metacarpal bone, 5-telescoping rode with 6-hinges joined together forming a complete hinge, 7-nuts and 8-slotted washers for K wire fixation.
Figure 5
Figure 5
Scaphoid non-union (SNU) in patient number 3, a preoperative radiograph.
Figure 6
Figure 6
A radiograph of the SNU in patient number 3 with the frame in situ.
Figure 7
Figure 7
A postoperative CT scan of the healed SNU in patient number 3.
See this image and copyright information in PMC

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