Percutaneous Fixation for Scaphoid Nonunion with Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw.

Abstract

BACKGROUND Percutaneous scaphoid screw fixation is a popular treatment for acute scaphoid fractures with no or minimal displacement. For treating scaphoid nonunions, however, open reduction and internal fixation with bone grafting is still the most popular treatment. Percutaneous fixation with bone grafting through the screw insertion hole has received little attention, although it minimizes damage to the surrounding tissues. We report excellent results of six scaphoid nonunions treated by retrograde percutaneous fixation with curettage and bone grafting through the distal insertion hole of a fully threaded headless screw. METHODS Six scaphoid nonunions with substantial bone loss were treated, including one revision case. All nonunions were located at the middle third of the scaphoid. The mean patient age at operation was 26 years, and the mean interval between fracture and surgery was 7 months. In the revision case, the interval between the primary and revision surgery was 6 months. In one case, curettage alone was performed before retrograde insertion of the headless screw. In the other cases including the revision, curettage and bone grafting with a bone biopsy needle was required through a distal insertion hole. RESULTS The mean follow-up was 11.3 months. Radiologically, union was achieved at averaged 12 weeks postoperatively. At the final follow-up, there was significant improvement in the wrist extension range of movement (from 65.8° to 80.8°) and grip strength (from 69.5% to 93.0% of the unaffected side). Five patients were free of pain, and one experienced mild pain only during heavy manual labor. The mean VAS, DASH, and Cooney wrist scores were 0.3, 1 and 99, respectively. All patients returned to their work or athletic activities. CONCLUSIONS Retrograde percutaneous fixation with bone grafting through the distal insertion hole of a fully threaded headless screw is a promising option for surgical treatment of scaphoid nonunions.

DOI: 10.1142/S242483551650034X

Cite this paper

@article{Ohta2016PercutaneousFF, title={Percutaneous Fixation for Scaphoid Nonunion with Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw.}, author={Souichi Ohta and Ryosuke Ikeguchi and Takashi Noguchi and Yukitoshi Kaizawa and Hiroki Oda and Hirofumi Yurie and Shuichi Matsuda}, journal={The journal of hand surgery Asian-Pacific volume}, year={2016}, volume={21 3}, pages={357-63} }