Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

Lee,  Jin Ho; Kim,  Myung Sun

doi:2014.19.1.36

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Original Article

Journal of the Korean Society for Surgery of the Hand 2014;19(1):36-43.
Published online March 30, 2014.
DOI: https://doi.org/10.12790/jkssh.2014.19.1.36

Pure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity

Jin Ho Lee, Myung Sun Kim

Department of Orthopedic Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea. mskim@jnu.ac.kr

Received: 29 January 2014 • Revised: 12 March 2014 • Accepted: 24 March 2014

Abstract

Purpose
We evaluated clinical and radiographic results of the pure cancellous bone grafting and internal fixation for the treatment of scaphoid waist nonunions with humpback deformity.

Methods
The subject of this study were 46 patients who had a scaphoid waist nonunion with humpback deformity treated with bone grafting between January 2005 and December 2011. The average follow-up period was 18.6 months (range, 12-26 months). We performed open reduction through an anterior approach with correction of the deformity and insertion of a screw from distal to proximal. We filled the resultant defect with pure cancellous autograft. The clinical results were evaluated with range of motion of the wrist joint, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score and visual analogue scale. For radiographic evaluation, we assessed lateral scapholunate angle and intrascaphoid angle.

Results
Bony union was achieved in 39 out of 46 patients (84.8%). DASH score significantly improved from 24.0 to 7.3 postoperatively. The modified Mayo wrist score also increased from 64.8 to 88.6 postoperatively. There were 17 excellent results 18 good results. The average scapholunate angle and intrascaphoid angle improved from 70.6degrees, 51.5degrees to 52.4degrees, 33.9degrees postoperatively.

Conclusion
Pure cancellous bone grafting and internal fixation provide good clinical result in patients with a scaphoid waist nonunion with successful restoration of the humpback deformity.

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