J Wrist Surg 2020; 09(02): 116-123
DOI: 10.1055/s-0039-3400510
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Drill and Fill Technique for the Treatment of Scaphoid Delayed Unions and Nonunions

Dennis S. Lee
1  Integrated Health Associates, Michigan Orthopaedic Center, Ypsilanti, Michigan
,
David T. Lee
2  Notre Dame Seminary, Graduate School of Theology, Program of Priestly Formation, New Orleans, Louisiana
,
Sasidhar Uppuganti
3  Department of Orthopaedics, Vanderbilt University Medical Center, Vanderbilt, Nashville, Tennessee
,
Daniel S. Perrien
4  Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
,
Nicholas D. Pappas III
5  Hand Surgical Associates, Metairie, Louisiana
,
Kaitlyn Reasoner
6  Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
,
Donald H. Lee
3  Department of Orthopaedics, Vanderbilt University Medical Center, Vanderbilt, Nashville, Tennessee
› Author Affiliations
Acknowledgements: This study was supported by NCAT UL1TR000445 and by U.S. Department of Veterans Affairs BLRD CDA2 IK2BX001634 awarded to D.S.P.
Further Information

Publication History

28 February 2019

10 October 2019

Publication Date:
26 November 2019 (online)

Abstract

Background This article reviews the results of a surgical technique using three iterations of drilling, autologous cancellous bone grafting (filling), and use of an intraosseous compression screw for the treatment of nondisplaced or minimally displaced scaphoid delayed unions or nonunions.

Methods Part 1—Cadaveric study: Three cadaveric scaphoids underwent stained cancellous bone graft packing and headless cannulated compression screw placement using a single iteration of drilling and graft packing. Three additional scaphoids were allocated to the triple “drill and fill” group, and underwent three iterations of drilling and graft packing before screw insertion. Graft particle distribution on mid-sagittal sections was assessed under fluorescence microscopy. Comparison of normalized areas between the single and triple “drill and fill” groups was performed using repeated measures ANOVA and Tukey's post hoc test.

Part 2—Clinical study: Twelve patients with minimally displaced scaphoid delayed unions and nonunions treated between April 2007 and December 2013 with the triple “drill and fill” technique were included. The average follow-up was 60.4 weeks. Two fellowship-trained musculoskeletal radiologists independently reviewed images for fracture healing.

Results By the histomorphometric analysis, there was improved autograft distribution along the screw tract, particularly within the proximal pole, with three iterations of drilling and filling. Clinically, 11 of 12 delayed unions and nonunions had healed.

Conclusion Our results support the use of the “drill and fill” technique as an option for the treatment of select nondisplaced or minimally displaced scaphoid nonunions and delayed unions at the waist without avascular necrosis of the proximal pole.

Level of Evidence This is a Level IV study.

Ethical Approval

The Vanderbilt University Institutional Review Board exempted the cadaveric portion of this study from IRB approval (IRB# 120525) and approved the chart review portion of the clinical study (IRB# 120754). Informed consent was waived for the chart review portion of the clinical study.