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J Hand Surg Eur Vol. 2018 Jan;43(1):32-40. doi: 10.1177/1753193417732003. Epub 2017 Sep 24.

Success of scaphoid nonunion surgery is independent of proximal pole vascularity.

Author information

1
1 College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
2
2 Department of Orthopedic Surgery, Hospital for Special Surgery/Weill Medical College of Cornell University, New York, NY, USA.
3
3 Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA.
4
4 Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA.
5
5 Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery/Weill Medical College of Cornell University, New York, NY, USA.

Abstract

We followed 35 consecutive patients with scaphoid nonunions in a prospective longitudinal registry. All nonunions were treated with curettage, non-vascularized autogenous grafting and headless screw fixation. Preoperative magnetic resonance imaging, intraoperative bleeding points and histopathological analysis of cancellous bone in the proximal pole were recorded as measures of viability. Healing was categorized as ≥50% bony bridging on computed tomographic images in the plane of the scaphoid. Nine of 23 proximal poles demonstrated ischaemia on magnetic resonance imaging but none were interpreted as infarcted. Twenty-eight of 33 were found to have impaired vascularity as assessed by intraoperative bleeding. Fourteen of 32 demonstrated ≥50% trabecular necrosis and four of 33 demonstrated ≥50% tissue necrosis on histopathological analysis. Thirty of 33 demonstrated focal or robust remodelling activity. Despite pathological evidence of impaired vascularity in over half of the patients, 33 of the 35 scaphoids had healed by 12 weeks. We conclude that proximal pole infarction is decidedly rare and that vascularized bone grafting is seldom required.

LEVEL OF EVIDENCE:

IV.

KEYWORDS:

Scaphoid nonunion; avascular necrosis; bone graft; non-vascularized; perfusion; proximal pole; vascularity; vascularized

PMID:
28945157
DOI:
10.1177/1753193417732003

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