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ORIGINAL RESEARCH

Screw Fixation Without Bone Grafting for Delayed Unions and Nonunions of Minimally Displaced Scaphoids

August 8, 2018 | Surgery
David Saper, MD ; Akash K. Shah, BA ; Andrew B. Stein, MD ; Andrew Jawa, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Saper is an Orthopaedic Surgeon, Section of Orthopaedic Sports Medicine, Orthopaedic and Rehabilitation Centers, Chicago, Illinois. He was a Chief Resident at the time the article was written. Mr. Shah is a Medical Student, Boston University School of Medicine, Boston, Massachusetts. Dr. Stein is an Assistant Professor, Boston University School of Medicine; and a Hand Surgeon, Department of Orthopaedics, Boston Medical Center, Boston, Massachusetts. Dr. Jawa is an Assistant Professor, Boston University School of Medicine, Boston, Massachusetts; and a Shoulder, Hand, and Wrist Surgeon, New England Baptist Hospital, Roxbury Crossing, Massachusetts.

Address correspondence to: David Saper, MD, 1431 N Western Ave, Suite 510, Chicago IL 60622 (email, Dave.saper@gmail.com).

David Saper, MD Akash K. Shah, BA Andrew B. Stein, MD Andrew Jawa, MD . Screw Fixation Without Bone Grafting for Delayed Unions and Nonunions of Minimally Displaced Scaphoids. Am J Orthop.

August 8, 2018

 

TAKE-HOME POINTS

  • Scaphoid nonunions can occur in minimally displaced fractures.
  • If there is no deformity of the scaphoid delayed or nonunion, then a percutaneous screw fixation without bone grafting can reliably lead to bony union. 
  • Not all scaphoid delayed unions and nonunions require bone grafting.

All these previous studies have demonstrated excellent union rates but using a limited series of patients. We reviewed a large number of consecutive patients with scaphoid delayed unions and nonunions treated by screw fixation without bone grafting. Our hospital is a safety net institution for a large urban catchment area and had complete radiographic and clinical data for 19 of our 23 patients. One patient was contacted by telephone and he reported no pain and no revision surgical interventions.

The limitations of this study include not only its retrospective design but also its limited secondary outcome measures. However, our primary outcomes of union, pain, and complications are of utmost importance to clinicians and patients alike. Similar to other authors, we used radiographs to confirm unions. Although bridging trabeculation in radiographs has been demonstrated as soon as 1 month after the injury, there may be problems with interobserver reliability.4,13,15,20,21

Patients being lost to follow-up is not uncommon in the orthopedic trauma literature and can influence results.22,23 It is speculative to infer that the 3 patients who did not complete a follow-up course did not return because their pain had mitigated.

CONCLUSION 

Like several fractures, the lack of stability and the absence of micro-motion are believed to contribute to fibrous nonunions in scaphoid fractures.13 This study provides a large consecutive cohort of patients with minimally displaced scaphoid delayed unions and nonunions that were successfully treated by rigid internal fixation without bone grafting. These results confirm previous reports that bone grafting is not required to provide predictable unions for the majority of scaphoid nonunions.

This paper will be judged for the Resident Writer’s Award.

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