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J Wrist Surg
DOI: 10.1055/s-0044-1779292
Procedure

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Brahman Shankar Sivakumar 
1   Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Hornsby, NSW, Australia
2   Department of Hand & Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
3   Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, NSW, Australia
4   Discipline of Surgery, Sydney Medical School, the Faculty of Medicine and Health, University of Sydney, Sydney, Australia
,
Soon Ghee Ang
5   Macquarie Hand Unit, Macquarie University Hospital, Macquarie University, NSW 2109, Australia
,
Nicholas Smith
5   Macquarie Hand Unit, Macquarie University Hospital, Macquarie University, NSW 2109, Australia
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Abstract

Background The optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union.

Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims.

Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures.

Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score.

Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.

Keywords

scaphoid - non-union - arthroscopy - screw fixation - bone grafting

This work was performed at the Macquarie Hand Unit, Macquarie University Hospital, Macquarie University, NSW 2109, Australia.




Publication History

Received: 24 April 2023

Accepted: 15 November 2023

Article published online:
02 February 2024

© 2024. Thieme. All rights reserved.

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