Is Scaphoid Reconstruction Still an Option for Scaphoid Nonunion With Established Arthritis? A Retrospective Study of a Group of Patients.

PURPOSE: Although many studies have supported salvage procedures as the best option for scaphoid nonunions with established arthritis, there remains uncertainty regarding when procedures to gain union are favored over salvage procedures. The purpose of this study was to evaluate whether the short-term results from scaphoid nonunion with established arthritis treated by scaphoid reconstruction are acceptable.

METHODS

We retrospectively studied the clinical outcomes of scaphoid nonunions with established arthritis treated by scaphoid reconstruction between January 2019 and December 2021. Eighteen patients with wrist arthritis beyond Vender stage II were included. The median interval between injury and surgery was 50 months (range, 12-252 months). Fifteen patients were available for a 3-year minimum follow-up. Assessments included visual analog scale scores for pain, range of motion, grip strength, as well as the Modified Mayo Wrist Score.

RESULTS

One-third of fractures healed at 8 weeks after surgery, and the rest healed before 12 weeks, as confirmed by computed tomography scan. At the 3-year minimum follow-up, average pain score, grip strength, and the Modified Mayo Wrist Score improved significantly compared with the preoperative values. The average active range of motion increased after surgery but was similar to the preoperative status. The range of motion or grip strength remained unchanged or even decreased after the surgery in three patients. At final follow-up, x-rays showed no obvious advancement of the wrist arthritis in any of the patients.

CONCLUSIONS

In our group of patients with established wrist arthritis, scaphoid reconstruction resulted in acceptable short-term outcomes.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.