Introduction

Scaphoid nonunion after failed primary treatment remains challenging particularly when entailed by bone loss, avascular necrosis or deformity. We describe a scaphoid augmentation and fixation technique for cases of recalcitrant nonunion after screw placement by autologous press fit corticocancellous dowel. This study aims to provide reliable data on clinical and radiological outcomes and to contextualize in the face of other treatment options.

Material and methods

The study included 16 patients with recalcitrant nonunion of the scaphoid. All patients received screw removal and scaphoid reconstruction by a dowel shaped non-vascularized corticocancellous bone graft from the iliac crest facilitating packing of the screw channel. Bone union, the scapholunate, radiolunate and intrascaphoidal angles were evaluated on X-ray and CT images, range of motion noted. Additionally grip strength, DASH and Green O’Brien scores were obtained from eight patients.

Results

A union rate of 73% was noted after mean follow-up of 54 months. After revisional reconstruction of the scaphoid an extension–flexion rate of 84% of the healthy side was noted while pronation-supination reached 101%. DASH score averaged at 2.9, rest pain on a numeric rating scale was 0.43 with 99% peak grip force of the healthy side.

Conclusion

In complex cases of revisional scaphoid nonunion after screw placement, the corticocancellous iliac crest pressfit dowel is an option for augmentation and stabilization of the scaphoid by preserving the articular surface.

Level of evidence

IV, retrospective case series.

中文翻译：

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皮质松质压入式髂嵴骨钉治疗顽固性舟状骨骨不连：愈合率和临床结果分析

介绍

初次治疗失败后舟状骨骨不连仍然具有挑战性，特别是当伴有骨质流失、缺血性坏死或畸形时。我们描述了一种舟骨增强和固定技术，用于通过自体压配合皮质松质销钉放置螺钉后顽固性骨不连的病例。本研究旨在提供有关临床和放射学结果的可靠数据，并结合其他治疗方案进行背景分析。

材料与方法

该研究纳入了 16 名舟状骨顽固性骨不连患者。所有患者均接受螺钉移除，并通过来自髂嵴的销钉形非血管化皮质松质骨移植物重建舟状骨，以促进螺钉通道的填塞。通过 X 射线和 CT 图像评估骨愈合、舟月骨、放射月骨和舟骨内角，并记录运动范围。此外，还从 8 名患者身上获得了握力、DASH 和 Green O'Brien 评分。

结果

平均随访 54 个月后，愈合率为 73%。舟状骨修正重建后，健康侧的伸展-屈曲率为 84%，而旋前-旋后达到 101%。DASH 评分平均为 2.9，数字评定量表上的静息疼痛为 0.43，健康侧的峰值握力为 99%。

结论

在螺钉放置后修复舟骨骨不连的复杂病例中，皮质松质骨髂嵴压配销钉是通过保留关节面来增强和稳定舟骨的一种选择。

证据级别

IV、回顾性病例系列。