Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis
Abstract
Objective: To report the consolidation rate and the outcomes of a series of 22 patients with proximal pole scaphoid nonunion treated with a metaphyseal core decompression and an anterograde self-compressing screw. Methods: We present a prospective series of patients with proximal pole scaphoid nonunion and confirmation of intraoperative bleeding in both fragments. Patients presenting with displacement, degenerative changes, proximal pole fragmentation, cavitation at the fracture site, reduced bone length, and necrosis, as well as those with carpal instability, were excluded. X-rays and computed tomography scans were performed to assess consolidation; range of motion and grip strength were recorded, and patients completed a visual analogue scale for pain at rest, pain during activity, and subjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results: Eighteen patients were included. Union was observed in 17 patients. The average follow-up time was 22 months, and the average final range of motion was as follows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnar deviation, and 85% for grip strength. The average score on the visual analogue scale was 0 for pain at rest, 2 for pain during activity, and 9 for function, while the average DASH score was 8. Conclusions: Using this simple and reliable technique, we obtained a 95% union and very good functional results. Metaphyseal core decompression with an antegrade screw is a valid and effective alternative for treatment of proximal pole scaphoid nonunion in carefully selected patients.Downloads
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