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Volar Plate Fixation to Treat Scaphoid Nonunion: A Case Series With Minimum 3 Years of Follow-Up.
Journal of Hand Surgery 2018 June
PURPOSE: Several options exist for treating scaphoid nonunion. For selected cases, some authors recommend using a volar buttress plate. The aim of the study was to report the clinical and radiological outcomes achieved at a minimum of 3 years' follow-up of treating scaphoid nonunion with a scaphoid volar plate.
METHODS: We retrospectively reviewed 15 patients with symptomatic scaphoid nonunion treated with scaphoid plate osteosynthesis and a bone graft from the volar aspect of the distal radius between January 2011 and November 2013. The patients' average age was 32 years (range, 21-62 years). No patient had undergone previous scaphoid surgery. Clinical assessments included wrist range of motion (ROM), grip strength, and a 10-point visual analog scale rating of pain. Further subjective assessment was performed using validated measurement tools. All patients underwent plain radiography with 6 different views and computed tomography before and after surgery. The scapholunate angle was measured to evaluate carpal alignment.
RESULTS: The mean follow-up period was 42 months (range, 36-51 months). Bone union was obtained in 13 of 15 patients (87%) at an average of 5 months (range, 3-8 months) after surgery. Significant improvements in the scapholunate angle and visual analog scale pain score were observed. However, both wrist ROM and grip strength remained significantly decreased relative to the opposite side (62% and 55% of normal, respectively). Four patients experienced hardware complications: plate breakage (1 scaphoid) and screw back-out (3 scaphoids). Impingement between the radial styloid and the scaphoid plate was identified in 6 patients. Five patients required additional surgery to remove the plate.
CONCLUSIONS: Our study indicates unsatisfactory results treating scaphoid nonunion with a volar scaphoid plate. Although the rate of union was comparable with that of other series, we noted more complications. We are concerned about both the high proportion of hardware complications and required secondary surgical procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
METHODS: We retrospectively reviewed 15 patients with symptomatic scaphoid nonunion treated with scaphoid plate osteosynthesis and a bone graft from the volar aspect of the distal radius between January 2011 and November 2013. The patients' average age was 32 years (range, 21-62 years). No patient had undergone previous scaphoid surgery. Clinical assessments included wrist range of motion (ROM), grip strength, and a 10-point visual analog scale rating of pain. Further subjective assessment was performed using validated measurement tools. All patients underwent plain radiography with 6 different views and computed tomography before and after surgery. The scapholunate angle was measured to evaluate carpal alignment.
RESULTS: The mean follow-up period was 42 months (range, 36-51 months). Bone union was obtained in 13 of 15 patients (87%) at an average of 5 months (range, 3-8 months) after surgery. Significant improvements in the scapholunate angle and visual analog scale pain score were observed. However, both wrist ROM and grip strength remained significantly decreased relative to the opposite side (62% and 55% of normal, respectively). Four patients experienced hardware complications: plate breakage (1 scaphoid) and screw back-out (3 scaphoids). Impingement between the radial styloid and the scaphoid plate was identified in 6 patients. Five patients required additional surgery to remove the plate.
CONCLUSIONS: Our study indicates unsatisfactory results treating scaphoid nonunion with a volar scaphoid plate. Although the rate of union was comparable with that of other series, we noted more complications. We are concerned about both the high proportion of hardware complications and required secondary surgical procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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