The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions

Abstract

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3-10) preoperatively to 1.59 (range, 0-3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1

Basic instrumentation. 2.7 mm video arthroscope, 2.0 and 2.9 mm shavers, 3.0 mm burr and radiofrequency probe for surgical instrument. Two custom-made cannulas (3.8 and 3.0 mm) and 2 custom-made trocars (3.2 and 2.7 mm) for percutaneous bone grafting.

Figure 2

Arthroscopic portals marked in the radiocarpal and midcarpal joints. ACC = accessory portal, MCR =  midcarpal radial, MCU = midcarpal ulnar.

Figure 3

A 48-year-old male patient with nonunion of the left scaphoid fracture. Preoperative left wrist plain posteroanterior (PA) with ulnar deviation and lateral. (A) View showing nonunion at the waist of the scaphoid. (B) Same patient's left wrist, mid-carpal arthroscopy image of scaphoid nonunion site shows large gap and sclerotic margin of distal fragment. P = proximal fragment, PA = posteroanterior, D = distal fragment.

Figure 4

Left wrist, midcarpal arthroscopy image of nonunion site after debridement. Showing punctuate bleeding from proximal and distal fragments. P =  proximal fragment, D =  distal fragment.

Figure 5

Arthroscopic view of provisional K-wire fixation.

Figure 6

Same patient's left wrist, midcarpal arhroscopy images of percutaneous autogenous iliac cancellous bone grafting at the nonunion site using cannula and trocar.

Figure 7

Immediate postoperative plain left wrist PA with ulnar deviation and lateral radiographs show internal fixation with K-wires and grafted bone at the nonunion site. PA = posteroanterior.

Figure 8

Postoperative 11 weeks K-wires removal plain left wrist plain PA with ulnar deviation and lateral radiographs shows complete bony union. PA = posteroanterior.