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. 2023 Jan 18;18(1):52.
doi: 10.1186/s13018-023-03529-7.

Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft

Cong Cheng  1 , Zongyuan Jiang  1 , Haoran Sun  1 , Jiaping Hu  1 , Yanggang Ouyang  2
Affiliations

Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft

Cong Cheng et al. J Orthop Surg Res. .

Abstract

Background: The treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment.

Purpose: This study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes.

Methods: It was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period.

Results: Significant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients.

Conclusions: The arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.

Keywords: Arthroscopy; Bone graft; Headless compression screw; Nonunion; Scaphoid fracture.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
A The preoperative plain radiograph of scaphoid nonunion in a 26-year-old man; B A reformatted CT scan shows the deformity of the sclerotic scaphoid nonunion
Fig. 2
Fig. 2
A Arthroscopic view of cleavage line in scaphoid articular surface at the nonunion site. B Punctate bleeding after adequate debridement. C Bone graft harvested from the distal radius is cut into small pieces and placed into a 1-mL syringe. D Bone graft is impacted into the defect site
Fig. 3
Fig. 3
A Two headless compression screws are inserted along the axial of the K-wires and advanced alternately. B Two screw heads are confirmed to be positioned beneath the articular surface of scaphoid under fluoroscopic examination
Fig. 4
Fig. 4
Union was achieved at 12 weeks after surgery, which was assessed by plain radiograph (A) and CT scan (B)
Fig. 5
Fig. 5
A Range of motion of the wrist is excellent at 12 months after surgery. B The scars are inconspicuous
See this image and copyright information in PMC

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