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
