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J Wrist Surg
DOI: 10.1055/s-0044-1779286
Scientific Article

A Small Ratio of Proximal to Distal Bone Fragments Is a Risk Factor for Scaphoid Nonunion: A Volumetric Analysis of Preoperative CT

Hirotaka Sugiura
1   Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
,
Masahiro Tatebe
1   Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
,
Hidemasa Yoneda
1   Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
,
Takanobu Nishizuka
2   Department of Orthopaedic Surgery, Nagoya Hand Surgery Center, Chunichi Hospital, Naka-ku, Nagoya, Japan
,
Akimasa Morita
3   Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan
,
Michiro Yamamoto
1   Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
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Abstract

Background Small proximal bone fragments are a known risk factor for nonunion, but it is not known what ratio of proximal to distal bone fragments actually results in nonunion.

Objective We hypothesized that a small proximal ratio of proximal scaphoid fragment volume to distal scaphoid volume as measured by preoperative computed tomography (CT) would be a risk factor for postoperative scaphoid nonunion.

Patients and Methods We retrospectively examined the factors that led to postoperative nonunion in 78 patients who underwent surgery using free bone grafts for scaphoid nonunion. Nonunion was defined as no evidence of union on plain radiography or CT more than 3 months after injury. Three-dimensional models of scaphoid fractures were created from the preoperative CT of all cases, and volumes were measured. Other patient characteristics, surgical methods, and imaging were investigated.

Results Persistent nonunion was observed in 13 patients after surgery, a rate of 16.7%. A multivariate analysis showed that only the proximal fragment ratio was an independent factor (union group 0.94, persistent nonunion group 0.54, p = 0.03). Receiver operating characteristic analysis showed that a proximal fragment ratio less than 0.66 was associated with persistent nonunion.

Conclusion Treatment of scaphoid nonunion with a small proximal fragment ratio should be based on a thorough understanding of the anatomy, blood flow, and carpal kinematics of the scaphoid bone itself.

Level of Evidence Level IV, prognostic study.

Keywords

bone volume - CT - nonunion - preoperative - scaphoid bone - scaphoid fracture

Ethical Review Committee Statement

The study protocol was approved by the Institutional Review Boards of each hospital, and consent was obtained from all patients.


Statement of the Location Where the Work Was Performed

Work on this study was performed at three collaborating hospitals where the following departments are located: Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine; Department of Orthopaedic Surgery, Nagoya Hand Surgery Center, Chunichi Hospital; and Department of Orthopaedic Surgery, Suzuka Kaisei Hospital.




Publication History

Received: 07 September 2023

Accepted: 27 December 2023

Article published online:
31 January 2024

© 2024. Thieme. All rights reserved.

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