Comparative evaluation of radiographic and functional outcomes in the surgical treatment of scaphoid non-unions.

OBJECTIVE

The aim of our study was to evaluate the correlation between the radiological signs of union and functional outcomes in patients with surgically treated scaphoid non-unions.

METHODS

In our study, we evaluated 13 patients who underwent surgery at our clinic for complaints resulting from an unhealed scaphoid fracture. Of the scaphoid non-unions, 9 were on the scaphoid body and 4 were on the proximal pole. According to Slade's classification system, there were two Grade 4, eight Grade 5, and three Grade 6 fractures. The patients were all male with a mean age of 31, with 25 months of mean time between the onset of trauma and surgery. All fractures were treated through open reduction with autogenous bone grafting (cancellous in 4 cases; corticocancellous in 9 cases) and fixation with compression screws. Bone morphology and carpal alignment were assessed through radiography, using the scaphoid index and scapholunate angle measurements, respectively. Range of motion and grip strength measurements together with the modified Mayo wrist scores were used in the assessment of wrist functionality.

RESULTS

Average duration of follow-up was 16 months. In 10 patients, radiological union was attained in a mean time of 12.4 weeks following the operation. There was a substantial improvement in grip strength and range of motion values after surgery. The preoperative mean modified Mayo wrist score of 41.5 improved to 79.2 postoperatively. Accordingly, 4 patients had perfect, 2 had good, 5 had fair and 2 had poor results. The surgical treatment allowed the preoperative mean scapholunate angle of 45.8° and the preoperative mean scaphoid index of 0.69 to be reduced to 32° and 0.6, respectively. The humpback deformity present in 11 patients before the surgery was restored in 10 patients by reconstruction of the scaphoid bone length. Abnormal carpal alignment was restored in 4 of these patients. No statistically significant correlation was found between the functional results and the surgically attained structural restorations and union process.

CONCLUSION

The surgical treatment of scaphoid fracture non-unions can correct bone morphology and resolve alignment problems but might not be sufficient for the improvement of functional results.