Abstract
Introduction and Aims: A non-union of the scaphoid has traditionally been managed by open reduction and internal fixation with bone grafting. The purpose of this study was to evaluate the healing rate of selected scaphoid non-unions managed by arthroscopic assisted fixation alone without supplemental bone grafting.
Method: Fifteen patients underwent arthroscopic fixation of a scaphoid nonunion without bone grafting. There were 14 males and one female. Average age was 20 years (range 17–28 years). A history of a scaphoid fracture was present an average of eight months prior to fixation (range 4–15 months). The lunate was neutral in all pre-operative radiographs without carpal collapse in order to be included in the study. There were 12 horizontal oblique fractures involving the middle third, one transverse fracture and two proximal third fractures. A guide wire was placed under fluoroscopic guidance and anatomic reduction of the fracture was assessed arthroscopically from the mid-carpal space. A headless cannulated compression screw was placed dorsal to volar. No patient underwent bone grafting. Fracture union was evaluated by CT scan and plain radiographs.
Results: All patients healed their fractures. Average time to union was 12 weeks (range 8–18 weeks). Average wrist extension was 50 degrees, flexion was 60 degrees, radial deviation 20 degrees and ulnar deviation 25 degrees. Utilising the Mayo Modified Wrist Score, there were 12 excellent and three good results. Arthroscopic assisted fixation of selected scaphoid non-unions without bone grafting yielded a 100 percent union rate with minimal morbidity in this series.
Conclusion: Placement of a cannulated screw under arthroscopic guidance avoided soft tissue stripping, preserved the blood supply to the fracture fragments, and yielded excellent range of motion in this series. This technique would not be recommended for patients with a humpback deformity or signs of carpal collapse where bone graft would be required to correct the flexion deformity of the scaphoid.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
