Is there a correlation between the scaphoid's morphology, the development of arthritis and the long-term functional outcomes in patients treated for nonunion with a bone graft?

INTRODUCTION

The main complication following scaphoid fracture is nonunion, which requires a surgical intervention to prevent the development of Scaphoid Nonunion Advanced Collapse (SNAC) wrist arthritis. In some cases, the bone eventually heals in malunion. There is a lack of published data on the clinical and radiological consequences of these malunions. The aim of our study was to determine if there was a correlation between the scaphoid's shape after bone graft treatment of a nonunion and the development of arthritis and to determine the strength of the correlation between the shape and clinical outcomes.

HYPOTHESIS: There is no correlation between the scaphoid's shape and the development of radiocarpal arthritis nor the clinical and functional outcomes in the long-term after nonunion treatment.

PATIENTS AND

METHODS

Fifty patients having a mean age of 27.5 ± 10.3 years (19-68) were included and followed for a mean of 92.2 ± 58.6 months (18-244). The scaphoid's shape was determined using CT data (LISA: lateral intrascaphoid angle, H/L: height/length ratio) and using radiographs (RLA: radiolunate angle). The clinical data (age, sex, dominant hand, smoking habits, occupation, work status at final follow-up), the operative data, potential complications and functional outcomes (DASH, MWS, PRWE) were collected during the final follow-up visit.

RESULTS

The mean RLA was 7.4 ± 11.1 ° (min -21; max +46), the mean LISA was 30.5 ± 5.8 (min 22 max 47) and the mean H/L was 0.6 ± 0.2 (min 0.5 max 0.8). The mean DASH was 17.7 ± 18.9 (min 0 max 63.6). PRWE was 26.3 ± 26.3 (min 0, max 127) and MWS was 82.7 ± 19 (min 25 max 100). There was no statistically significant correlation between the scaphoid's shape and the development of arthritis (p = 0.38 for RLA, p = 0.24 for LISA, p = 0.38 for H/L), nor between the scaphoid's shape and the clinical or functional outcomes at a mean follow-up of 7.7 years.

CONCLUSION

In this study, the development of arthritis and the clinical outcomes were not correlated with the scaphoid's shape after nonunion treatment by bone graft, whether vascularized or not.

LEVEL OF EVIDENCE: IV; retrospective study.