| Abstrakt: |
Purpose: Cavitary type scaphoid nonunions represent a difficult treatment challenge as they exhibit bone loss, scaphoid shortening, flexion (“humpback”) deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. We present our technique for these problematic cavitary nonunions and discuss its rationale. Methodology: A retrospective analysis was undertaken on a consecutive cohort of 19 patients that were treated by the relatively simple method of (1) excising the nonunion via a volar approach (2) packing the volar defect with cancellous autograft, harvested from the ipsilateral distal radius and (3) holding it out to length with two Kirschner wires and a plaster cast. Wires are removed at 10–12 weeks. Results: Union was achieved in (18/19) 95% of cases, with no complications, in an average of 9.7 (range 8–12) weeks. Carpal mechanics were restored, with an average carpal height index of 1.52 ± 0.07 and an average scapholunate angle of 46 ± 10 degrees. Average follow up was 2.2 years. Conclusion: In this subset of patients we believe this technique is less technically demanding than the use of either corticocancellous grafts or various compression screws. Our success equals that of other published techniques, with all patients enjoying a full return to work even in occupations demanding heavy labour. We believe this may also be due to the ability of cancellous grafts to restore carpal height and normal carpal angles, thereby producing a better functional outcome. [ABSTRACT FROM AUTHOR] |
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