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However, double screws and plate fixation showed no significant differences when compared, in any of the biomechanical parameters. We have previously compared biomechanically the latter three fixation options and have shown that both double screws and plate fixation provide significantly greater stability and stiffness, especially in rotation, when compared with single-screw fixation in a scaphoid nonunion model. However, achieving biomechanically stability of the scaphoid with this defect poses two challenges: (1) obtaining adequate bone contact and (2) interfragmentary compression.Ĭompromise in either or both of these two factors can lead to increased instability across the fracture, thus affecting union rates.Ĭurrent fixation options include the use of K-wires, single or double headless compression screws and plates. Scaphoid nonunions are often associated with cystic changes and collapse and it is frequently observed that, after clearance of all the nonunion tissue and correcting the scaphoid alignment, there is a degree of bone loss which requires bone grafting to fill in the defect. However, it is the most commonly injured carpal bone, responsible for 50 to 80% of all carpal fractures.ĭue to the extensive articular surface, its unique shape and its tenuous retrograde blood supply, this makes scaphoid fractures susceptible to nonunion.Īpproximately 10 to 15% of all scaphoid fractures progress on to nonunion, invariably requiring surgical management, as failure to restore stability to the scaphoid eventually leads to predictable degenerative changes and eventual scaphoid nonunion advanced collapse (SNAC). The scaphoid plays a significant role in the overall kinematics and stability of the wrist. This is a Level IV, retrospective case series study. This potentially allows for earlier return to function, without compromise to union rates. The other patient refused further intervention as he was asymptomatic.ĭouble-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4–9.2 months). The average time from initial injury was 16 months (range, 3–144 months). Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities.Īll but one patient was male, and the mean age was 23 years (range, 15–38 years). Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss.

$scaphoid fracture surgery$

Scaphoid fracture surgery