Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis
11 May 2018
09 May 2019
11 July 2019 (online)
Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw.
Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed.
Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8.
Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients.
Level of Evidence This is Level IV study.
Protection of Human and Animal Subjects: The authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of Data: The authors declare that no patient data appear in this article.
Right to Privacy and Informed Consent: The authors declare that no patient data appear in this article.
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