Treatment for scaphoid fracture and nonunion-the application of 3.0 mm cannulated screws and pedicle vascularised bone grafts

摘要

Background: Scaphoid fractures are very common in wrist trauma, and scaphoid nonunions with avascular necrosis are frequent complications of a fractured scaphoid. The purpose of these two retrospective studies was to examine the clinical and x-ray results of treatments for acute scaphoid fracture and scaphoid nonunion. The surgical techniques of cannulated screw fixation and pedicled vascularised bone graft are described.Methods: From 2001-2004, 80 patients with scaphoid fractures were treated with 3.0 mm cannulated screws and 5.5 mm threaded washers in our hospitals. The average age was 35 years, and the average time from injury to surgery was 16.5 hours. Outcomes were assessed by x-ray and the modified Mayo wrist score system. During the 6-year period of 1998-2004, 72 patients with scaphoid nonunions were treated using pedicled vascularised bone graft (VBG)in our hospitals. The average age was 38.5 years, and the average time from injury to surgery was 9.5 months. Results: The union rate was 96.25% and satisfactory function rate was 93.75% in acute scaphoid fractures with an average follow-up of 3.5 years. The union rate (90.28%) and satisfactory function rate (81.94%) achieved in scaphoid nonunions were acceptable, with an average follow-up of 5 years.Conclusions: Our studies suggested that appropriate application of a cannulated screw and threaded washer was able to produce satisfactory results in scaphoid fracture, and that pedicled vascularised bone graft was effective for treating scaphoid nonunion.