TREATMENT OF DELAYED/NON-UNION OF THE SCAPHOID WITH THE SYNTHES CANNULATED SCREW & BONE GRAFT

Résumé fourni par la source

Background: Fracture of the scaphoid bone is the most common fracture of the carpus and frequently diagnosis is delayed. The unique anatomy & blood supply of the scaphoid itself predisposes to delayed union or non-union. The Synthes scaphoid screw is a cannulated headed screw, which provides superior compression compared with some other devices used to internally fix scaphoid non-unions. Aim: To conduct a retrospective study looking at union rate, time to union and complications and correlating the outcome of treatment against the delay between injury and surgery and location of the fracture within the bone. Methods: 36 patients with scaphoid non-union (30 waist & 6 proximal pole) treated by a single surgeon with the cannulated Synthes screw & corticocancellous bone graft were reviewed retrospectively. Results: We achieved 78% overall union rate. Those patients operated within 6 months of injury achieved 100% union rate. Of the patients with persistent non-union after surgery, half reported no pain and increased movement in the wrist. The failure rate was high in patients whose injury was more than 5 years old, and in proximal pole non-unions. Conclusion: Our study demonstrates that cannulated screw fixation with bone grafting has high success rate for delayed union of scaphoid waist fractures and scaphoid waist nonunions present for less than 5 years. Patients who present more than 5 years after injury or with proximal pole nonunions have a high chance of persistent nonunion, but can symptomatically improve.

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