Abstract
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.
Keywords
scaphoid - proximal pole - nonunion
