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CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2023; 51(02): e85-e95
DOI: 10.1055/s-0043-1777079
Artículo Original | Original Article

Percutaneous Fixation Without Graft vs Open Fixation with Graft in Delayed Stable Consolidation of the Scaphoid: Retrospective Analysis

Article in several languages: español | English
José Ignacio Miró 
1   Unidad de Miembro Superior, Clínica de la Mano de Buenos Aires (CLIMBA), Buenos Aires, Argentina
,
Alfonso García Vaquero
2   Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Costa del Sol, Málaga, España
,
Carlos José Lupotti
1   Unidad de Miembro Superior, Clínica de la Mano de Buenos Aires (CLIMBA), Buenos Aires, Argentina
,
Gustavo Luis Gómez Rodríguez
1   Unidad de Miembro Superior, Clínica de la Mano de Buenos Aires (CLIMBA), Buenos Aires, Argentina
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Abstract

Introduction The most appropriate surgical management of delayed symptomatic scaphoid consolidation remains controversial. Few studies compare different treatment options. This study aimed to compare the outcomes from percutaneous osteosynthesis with no associated bone graft and open reduction and internal fixation with cancellous autograft for stable delayed scaphoid consolidation.

Material and Methods A retrospective study included 24 patients: 13 subjects underwent percutaneous osteosynthesis without graft, while 11 patients underwent open reduction and internal fixation with associated cancellous graft. The main study variable was the average consolidation time in weeks. We determined the following secondary variables before and after surgery. The secondary radiological included the scapholunate angle, scapholunate distance, capitolunate angle, radiolunate angle, scaphoid length, and lateral intrascaphoid angle. The secondary functional variables at 6, 12, and 24 weeks included range of motion in flexion and extension, radial and ulnar deviation, pain according to the visual analog scale (VAS), the Quick Disability of Arm Shoulder and Hand (DASH) questionnaire, and the Patient-Rated Wrist Evaluation (PRWE) score, average number of physical therapy sessions, and average time to return to work. The Mann-Whitney U test analyzed quantitative variables, while the chi-square test analyzed qualitative variables at a significance level set at p < 0.05.

Results The mean time until surgery was 10 weeks in the group without graft and 23 weeks in the group with graft. The mean consolidation time in the group without graft was 10 weeks (range, 8 to 12 weeks) and 12 weeks (range, 8 to 20 weeks) in the group with graft. The consolidation rate was 100% in all cases. Differences favored the group without graft for the following parameters: visual analog scale (VAS) for pain at 3 months (5 vs. 7, p = 0.002), 6 months (3 vs, 6, p = 0.000), and 1 year (1 vs. 2, p = 0.001); DASH at 1 year (9 vs. 24, p = 0.000); PRWE score at 1 year (6 vs. 10, p = 0.011), mean flexion at 6 months (65° vs. 45°, p = 0.010); mean extension at 6 months (70° vs. 46°, p = 0.009); and ulnar deviation at 6 months (25° vs. 15°, p = 0.047). Differences favored the group with graft for the radial deviation at 6 months (15° vs. 12°, p = 0.038). The average time to resume working was 8 weeks in both groups.

Conclusion For surgical treatment of delayed consolidation in scaphoid fractures with no instability, percutaneous osteosynthesis without a bone graft could be superior to open reduction and internal fixation with cancellous autograft regarding radiological consolidation time and functional recovery.

Keywords

scaphoid pseudoarthrosis - percutaneous osteosynthesis - internal fixation - bone graft


Publication History

Received: 31 August 2022

Accepted: 16 August 2023

Article published online:
05 December 2023

© 2023. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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