Dorsal percutaneous screw fixation of delayed scaphoid fractures augmented with bone marrow injection | ||
| The Egyptian Orthopaedic Journal | ||
| Volume 55, Issue 4, October 2020, Pages 216-224 PDF (11.33 M) | ||
| DOI: 10.4103/eoj.eoj_58_21 | ||
| Authors | ||
| Eslam A. Tabl; Wael A. Kandel | ||
| Abstract | ||
| Background The management of delayed scaphoid fractures in physically demanding patients remains controversial. This article discusses a simple treatment that accelerates healing and allows early mobilization. The purpose of the study was to evaluate results of percutaneous headless compression screw fixation with bone marrow injection in scaphoid delayed-union fractures, which allows early mobilization of wrist to achieve early return to activities of daily living (ADL). Patients and methods A total of 20 patients (22 scaphoid) with scaphoid delayed-union fractures underwent percutaneous headless screw fixation with bone marrow injection from iliac bone. The inclusion criteria in this series were scaphoid delayed-union fractures with intact cartilaginous envelope, no sclerosis, and no avascular necrosis. Results The mean follow-up period as 20.4 months (range: 12–24), the average radiographic union was 7.8 weeks (range: 6–10 weeks), and the average visual analog scale score was 0.05 (range: 0–1). Average wrist range of motion was flexion of 85° (range: 75–90), extension 76.5° (range: 70–85), radial tilt 18.5° (range: 15–20), and ulnar tilt 42.5° (range: 39–45). The average grip strength was 95% (85–100%). Conclusion Percutaneous technique fixation for scaphoid fractures is a reliable and less harmful method and helps in early return to activity. The dorsal approach allows proper screw positioning and allows the use of hook to correct minimal displacement and gain best compression at the fracture site. Refreshing of the fracture ends by k-wire and bone marrow injection help to accelerate union with the less-invasive method. The best results of the percutaneous technique in delayed-union scaphoid fractures are achieved with intact cartilaginous envelope, no sclerosis, and no avascular necrosis. Level of evidence This was a level IV therapeutic study. | ||
| Keywords | ||
| bone marrow injection; nonunion; Percutaneous fixation; scaphoid fixation; Scaphoid fractures | ||
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