Arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yong ,  FU Yongbin , MA Mingming , MEI Siwei

Microsurgical Repair and Reconstruction Ward of Department of Orthopaedics, Fu Yang People’s Hospital, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

FU Yongbin, Email: 95224436@qq.com

Keywords：

Wrist arthroscopy; scaphoid fracture nonunion; Kirschner wire; screw; internal fixation; bone graft

DOI：

10.7507/1002-1892.202307059

Video：

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Objective To explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation. Methods The clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation. Results All patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation (t=12.851, P<0.001; t=−14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair. Conclusion Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.

Citation： LI Yong, FU Yongbin, MA Mingming, MEI Siwei. Arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1386-1389. doi: 10.7507/1002-1892.202307059 Copy

1.	Mathoulin CL, Arianni M. Treatment of the scaphoid humpback deformity—is correction of the dorsal intercalated segment instability deformity critical? J Hand Surg (Eur Vol), 2018, 43(1): 13-23.
2.	Pinder RM, Brkljac M, Rix L, et al. Treatment of scaphoid nonunion: A systematic review of the existing evidence. J Hand Surg (Am), 2015, 40(9): 1797-1805.
3.	赵喆, 何百昌, 谢永廉, 等. 关节镜下自体骨移植经皮内固定治疗腕舟骨骨不连的临床疗效. 中华骨科杂志, 2019, 39(11): 699-706.
4.	Huang YC, Liu Y, Chen TH. Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert’s screw fixation—a study of 49 patients for at least five years. Int Orthop, 2009, 33(5): 1295-1300.
5.	Lee YK, Choi KW, Woo SH, et al. The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions. Medicine (Baltimore), 2018, 97(13): e9987.
6.	Meermans G, Van Glabbeek F, Braem MJ, et al. Comparison of two percutaneous volar approaches for screw fixation of scaphoid waist fractures: radiographic and biomechanical study of an osteotomy-simulated model. J Bone Joint Surg (Am), 2014, 96(16): 1369-1376.
7.	Buijze GA, Doornberg JN, Ham JS, et al. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg (Am), 2010, 92(6): 1534-1544.
8.	Wong TC, Ip FK. Minimally invasive management of trans-scaphoid perilunate fracture-dislocations. Hand Surg, 2008, 13(3): 159-165.
9.	何信坤, 陈宏, 尹维刚, 等. 腕舟骨骨折骨不连的治疗进展. 中华创伤杂志, 2018, 34(6): 562-568.
10.	齐伟亚, 刘波, 朱辉, 等. 腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合. 中华创伤骨科杂志, 2020, 22(8): 730-732.
11.	滕晓峰, 陈宏, 王欣, 等. 腕关节镜辅助下经皮克氏针固定治疗腕舟骨新鲜骨折. 中华创伤杂志, 2018, 34(9): 773-780.
12.	Hsiung W, Huang HK, Wang JP, et al. Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius. Int Orthop, 2021, 45(1): 191-197.
13.	Jurkowitsch J, Dall’Ara E, Quadlbauer S, et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg, 2016, 136(11): 1623-1628.
14.	欧阳阳钢, 孙浩然, 姜宗圆, 等. 腕关节镜辅助下双枚Herbert螺钉经皮内固定微创治疗不稳定腕舟骨骨折. 中华手外科杂志, 2021, 37(2): 142-144.
15.	Lamon B, Ardouin L, Bellemère P, et al. Arthroscopic bone grafting for scaphoid nonunion: A retrospective study of 42 Cases. J Hand Surg (Asian Pac Vol), 2021, 26(4): 545-554.
16.	Waitayawinyu T, Lertcheewanan W, Boonyasirikool C, et al. Arthroscopic treatment of scaphoid nonunion with olecranon bone graft and screw fixation leads to union and improved outcomes. Arthroscopy, 2022, 38(3): 761-772.
17.	Del Piñal F, Clune J. Arthroscopic management of intra-articular malunion in fractures of the distal radius. Hand Clin, 2017, 33(4): 669-675.
18.	刘波, 陈山林, 朱瑾, 等. 干关节镜技术在腕关节镜治疗腕关节损伤中的疗效评价. 中华创伤杂志, 2019, 35(3): 241-246.

1. Mathoulin CL, Arianni M. Treatment of the scaphoid humpback deformity—is correction of the dorsal intercalated segment instability deformity critical? J Hand Surg (Eur Vol), 2018, 43(1): 13-23.
2. Pinder RM, Brkljac M, Rix L, et al. Treatment of scaphoid nonunion: A systematic review of the existing evidence. J Hand Surg (Am), 2015, 40(9): 1797-1805.
3. 赵喆, 何百昌, 谢永廉, 等. 关节镜下自体骨移植经皮内固定治疗腕舟骨骨不连的临床疗效. 中华骨科杂志, 2019, 39(11): 699-706.
4. Huang YC, Liu Y, Chen TH. Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert’s screw fixation—a study of 49 patients for at least five years. Int Orthop, 2009, 33(5): 1295-1300.
5. Lee YK, Choi KW, Woo SH, et al. The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions. Medicine (Baltimore), 2018, 97(13): e9987.
6. Meermans G, Van Glabbeek F, Braem MJ, et al. Comparison of two percutaneous volar approaches for screw fixation of scaphoid waist fractures: radiographic and biomechanical study of an osteotomy-simulated model. J Bone Joint Surg (Am), 2014, 96(16): 1369-1376.
7. Buijze GA, Doornberg JN, Ham JS, et al. Surgical compared with conservative treatment for acute nondisplaced or minimally displaced scaphoid fractures: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg (Am), 2010, 92(6): 1534-1544.
8. Wong TC, Ip FK. Minimally invasive management of trans-scaphoid perilunate fracture-dislocations. Hand Surg, 2008, 13(3): 159-165.
9. 何信坤, 陈宏, 尹维刚, 等. 腕舟骨骨折骨不连的治疗进展. 中华创伤杂志, 2018, 34(6): 562-568.
10. 齐伟亚, 刘波, 朱辉, 等. 腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合. 中华创伤骨科杂志, 2020, 22(8): 730-732.
11. 滕晓峰, 陈宏, 王欣, 等. 腕关节镜辅助下经皮克氏针固定治疗腕舟骨新鲜骨折. 中华创伤杂志, 2018, 34(9): 773-780.
12. Hsiung W, Huang HK, Wang JP, et al. Arthroscopic realignment and osteosynthesis of unstable scaphoid nonunion with cancellous bone graft from the ipsilateral radius. Int Orthop, 2021, 45(1): 191-197.
13. Jurkowitsch J, Dall’Ara E, Quadlbauer S, et al. Rotational stability in screw-fixed scaphoid fractures compared to plate-fixed scaphoid fractures. Arch Orthop Trauma Surg, 2016, 136(11): 1623-1628.
14. 欧阳阳钢, 孙浩然, 姜宗圆, 等. 腕关节镜辅助下双枚Herbert螺钉经皮内固定微创治疗不稳定腕舟骨骨折. 中华手外科杂志, 2021, 37(2): 142-144.
15. Lamon B, Ardouin L, Bellemère P, et al. Arthroscopic bone grafting for scaphoid nonunion: A retrospective study of 42 Cases. J Hand Surg (Asian Pac Vol), 2021, 26(4): 545-554.
16. Waitayawinyu T, Lertcheewanan W, Boonyasirikool C, et al. Arthroscopic treatment of scaphoid nonunion with olecranon bone graft and screw fixation leads to union and improved outcomes. Arthroscopy, 2022, 38(3): 761-772.
17. Del Piñal F, Clune J. Arthroscopic management of intra-articular malunion in fractures of the distal radius. Hand Clin, 2017, 33(4): 669-675.
18. 刘波, 陈山林, 朱瑾, 等. 干关节镜技术在腕关节镜治疗腕关节损伤中的疗效评价. 中华创伤杂志, 2019, 35(3): 241-246.

Chinese Journal of Reparative and Reconstructive Surgery

Arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation

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