Success of scaphoid nonunion surgery is independent of proximal pole vascularity. Academic Article uri icon

Overview

abstract

  • UNLABELLED: We followed 35 consecutive patients with scaphoid nonunions in a prospective longitudinal registry. All nonunions were treated with curettage, non-vascularized autogenous grafting and headless screw fixation. Preoperative magnetic resonance imaging, intraoperative bleeding points and histopathological analysis of cancellous bone in the proximal pole were recorded as measures of viability. Healing was categorized as ≥50% bony bridging on computed tomographic images in the plane of the scaphoid. Nine of 23 proximal poles demonstrated ischaemia on magnetic resonance imaging but none were interpreted as infarcted. Twenty-eight of 33 were found to have impaired vascularity as assessed by intraoperative bleeding. Fourteen of 32 demonstrated ≥50% trabecular necrosis and four of 33 demonstrated ≥50% tissue necrosis on histopathological analysis. Thirty of 33 demonstrated focal or robust remodelling activity. Despite pathological evidence of impaired vascularity in over half of the patients, 33 of the 35 scaphoids had healed by 12 weeks. We conclude that proximal pole infarction is decidedly rare and that vascularized bone grafting is seldom required. LEVEL OF EVIDENCE: IV.

publication date

  • September 24, 2017

Research

keywords

  • Bone Transplantation
  • Fracture Fixation, Internal
  • Fractures, Ununited
  • Scaphoid Bone

Identity

Scopus Document Identifier

  • 85041709581

Digital Object Identifier (DOI)

  • 10.1177/1753193417732003

PubMed ID

  • 28945157

Additional Document Info

volume

  • 43

issue

  • 1