Management of Scaphoid Nonunion With Iliac Crest Graft and K-wire Fixation: An Economically Viable Option.

Purpose This study details the functional results, patient satisfaction, and cost-effectiveness of patients treated with Fisk-Fernandez surgery using iliac crest graft and K-wire for scaphoid nonunion. Materials and methods This study involved a retrospective analysis conducted between November 2022 and August 2024. Forty-two patients diagnosed with scaphoid nonunion were treated using a surgical approach that included autologous bone grafting combined with K-wire fixation to promote bone healing and stability. To enable comparison, the QuickDASH-9 score, visual analog scale (VAS), and patient-rated wrist evaluation (PRWE) score were used for both preoperative and postoperative evaluations at the final follow-up. Results Our study group received treatment for an average of 16 months post-injury, ranging from 6 to 28 months. The average time of union was six months, ranging from four to 18 months. The study significantly improved QuickDASH-9 scores, grip strength, PRWE scores, and VAS for pain. The study reported no complications, and all patients returned to their basic activities of daily living. Conclusion Results of this study show that displaced scaphoid nonunions can be successfully treated with K-wire fixation combined with iliac crest bone grafting utilizing the Fisk-Fernandez approach.

Normative Radiographic Measurements of Scaphoid in a Sample Indian Population.

Introduction Wrist parameters measured on direct radiography are essential in diagnosing scaphoid-related pathologies and treatment. Although computed tomography has been used to establish normative for scaphoid measurement, no research has focused on Indian norms. This study aimed to determine the distribution and normal limits of parameters measured in our population's posteroanterior (PA) and direct lateral radiographs of the wrist. Materials and Methods Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology information system-picture archiving and communication system was used to collect standard digitized normal X-rays without significant osseous pathology over a year. The sample size was 600, distributed among age groups 18 to 30, 31 to 50, and 51 years and above. Scaphoid length, scaphoid width, scapholunate ratio, and scapholunate distance using both Cautilli and Gilula techniques were measured on a PA view, and scapholunate, radioscaphoid, and intrascaphoid angles were measured on a lateral view. As the lunate morphology is supposed to affect carpal kinematics with the scaphoid, the same was evaluated using the Viegas classification. Results A total of eight measurements were documented. Scaphoid length, scaphoid width measurements, and lateral intrascaphoid angle were more in males than in females and were found to be statistically significant. No other parameters showed any significance in terms of age and relation to lunate morphology. Conclusion The study offers a comprehensive analysis of measuring parameters specific to the Indian population. For the first time, the measurement of scapholunate distance was conducted utilizing two distinct methodologies. The normative intrascaphoid angle range and clinical implications were determined.

Reconstructing the Future: Long-Term Outcome of a Case of Scaphoid Dislocation With Concurrent Hamate and Triquetrum Fractures.

Scaphoid dislocations are an extremely rare injury. The authors herein report a 60-year-old male who was managed with open reduction and internal fixation with Kirschner wires (K-wires) and scapholunate ligament stabilisation. The aim of this case report is to comprehensively present this unusual injury along with its treatment and long-term follow-up outcome alongside a literature review to aid surgeons confronted with this rare pathology.

Developing 3D-Printed Wrist Splints for Distal Radius and Scaphoid Fractures.

Background The purpose of this study is to optimize conservative treatment of distal radius and scaphoid fracture, in terms of comfort, fracture stabilization, and prevention of cast complications. Description of Technique Advances in additive manufacturing have allowed the development of patient-specific anatomical braces (PSABs) which have the potential to fulfill this purpose. Our specific aims were to develop a model of PSAB, adapted to fracture care, to evaluate if this brace would be well tolerated by healthy volunteers and to determine its mechanical properties as compared with conventional methods of wrist immobilization. Materials and Methods Several three-dimensional-printed splint prototypes were designed by mechanical engineers based on surgeons' and hand therapists' clinical expertise. These experimental braces underwent testing in a preclinical study involving 10 healthy volunteers, assessing comfort, satisfaction, and activities. The final prototype was mechanically compared with a conventional cast and a prefabricated splint, testing different closing systems. A mathematical algorithm was created to automatically adapt the final PSAB model to the patient's anatomy. Results The final prototype achieved an overall satisfaction score of 79%, weighing less than 90 g, made from polyamide, and fixed using hook and loop straps. The PSAB stiffness varied between 0.64 and 0.99 Nm/degree, surpassing the performance of both conventional plaster casts and prefabricated splints. Conclusion The final wrist PSAB model, adapted for fracture treatment, is lightweight, comfortable, and provides anatomical contention. It is currently being tested for the treatment of stable distal radius and scaphoid fractures in comparison to conventional plaster cast.

Proximal Scaphoid Reconstruction Techniques Comparison of Three Techniques for Proximal Scaphoid Recontruction.

Introduction The costo-osteochondral autograft, vascularized medial femoral trochlear osteochondral autograft, and proximal hamate autograft have been used for the reconstruction of unsalvageable proximal pole scaphoid nonunions. Our hypothesis is that there is no difference in carpal kinematics after the proximal pole of the scaphoid is reconstructed with these three graft options. Methods Wireless sensors were mounted to the carpus that was loaded through cyclical motion. Each specimen was tested under a series of the three reconstructed conditions and their kinematics compared. Results No significant differences were found in scapholunate and lunocapitate joint motion during wrist flexion-extension and wrist radioulnar deviation between the three reconstructed conditions ( p > 0.05). Discussion and Conclusion There are minimal differences in carpal kinematics when comparing reconstruction of the proximal pole of the scaphoid with the costoosteochondral, medial femoral trochlear, and proximal hamate grafts.

Titanium patient-specific scaphoid replacement for unreconstructable nonunions: a case series study.

Although reconstruction is the preferred treatment option for symptomatic scaphoid nonunions, this may not be an option due to inadequate bone quality or degenerative changes. Existing salvage procedures tend to compromise function. This study introduces an alternative approach through the utilisation of a 3-D-printed titanium patient-specific scaphoid implant. In this retrospective case series, the outcomes of 12 patients treated for an unreconstructable scaphoid nonunion with a 3-D-printed prosthesis were evaluated. Patient-reported outcomes, range of motion, grip strength and plain radiographs were assessed pre- and postoperatively. The mean follow-up was 2 years and 8 months. Range of movement and patient-reported outcome scores improved postoperatively, although improvement in movement was not significant. Except for one, all implants showed satisfactory alignment on radiographs without any further degenerative changes. 3-D-printed titanium scaphoid replacement may be an alternative to salvage procedures for unreconstructable scaphoid nonunion.Level of evidence: IV.

Diagnosis of occult scaphoid fractures: an exploratory study to assess whether clusters of clinical features are diagnostic in comparison to reduced sequence magnetic resonance imaging.

BACKGROUND: Occult scaphoid fractures are difficult to diagnose radiographically. Evidence regarding prevalence and diagnostic accuracy of clinical tests is growing; however, gaps in knowledge remain and further research is needed. PURPOSE: This study aimed to determine the prevalence of occult scaphoid fractures and other hand/wrist fractures, plus any clinical/demographic findings diagnostic of scaphoid fractures. METHODS: Prognostic prospective cohort study. Patients referred with diagnosis of occult scaphoid fractures, non-diagnostic radiographs, and one or more positive provocative test for scaphoid fractures were included. Clinical data were compared to reduce sequence magnetic resonance imaging. Univariate logistic regression was used to determine significance. Multivariable logistic regression was used to determine the effect size of these variables. RESULTS: Of 197 included participants, 43(22%) had a scaphoid fracture and 59(30%) had an occult fracture other than scaphoid. Average age of patients with confirmed occult scaphoid fractures was 22 years old. Distal pole fractures were the most common scaphoid fracture (n = 28/65.1%, average age 16.9 years). Three clinical tests (pain with ulnar-deviation, anatomical snuffbox swelling and pain-free grip) plus two demographics (age <23 and male) resulted in accuracy of 81.7%, positive predictive value of 73.3%, and negative predictive value of 82.4% in diagnosing scaphoid fractures. CONCLUSION: This study confirms a high prevalence of occult fractures in our population. Patients demonstrating the relevant demographics and positive clinical tests may be appropriate to treat as scaphoid fractures without advanced imaging. Most patients will present with differing clinical findings and/or demographics, and routine use of magnetic resonance imaging is recommended.

Bilateral ST-coalition with thumb hypoplasia and scaphoid synchondrosis.

Carpal coalitions are rare wrist anomalies and are most often diagnosed incidentally. Due to their infrequent occurrence, there is a lack of treatment guidelines in the literature. We present a case study of a 13-year-old boy who presented with symptomatic synchondrosis in both scaphoids along with a bilateral osseous coalition between the scaphoid and trapezium bones in combination with bilateral thumb hypoplasia. We initiated a 10-week immobilization of the wrist, followed by gradual increasing weight-bearing. The patient showed significant symptom relieve after immobilization, further supporting the conservative treatment. In conclusion, a definitive treatment recommendation cannot be made. For young patients, we suggest initiating conservative treatment as the first option. A precise analysis of the pathology and wrist kinematics is mandatory to recommend further therapy especially if operative interventions might be considered.

Multi-objective constraints for path planning in screw fixation of scaphoid fractures.

PURPOSE: Scaphoid fractures, a common type of clinical fracture, often require screw placement surgery to achieve optimal therapeutic outcomes. Path planning algorithms can avoid more risks and have vital potential for developing precise and automatic surgeries. Despite the success of surgical path planning algorithms, automatic path planning for scaphoid fractures remains challenging owing to the complex bone structure and individual variations. METHODS: Thus, we propose a Multi-objective constrained Path planning Algorithm (MPA) for fracture screw placement, which includes the identification of the center of the fracture surface. Further, three constraint conditions were introduced to eliminate infeasible paths, followed by adding three objectives to the remaining paths for more accurate planning. Finally, the Nondominated Sorting Genetic Algorithms (NSGA)-II algorithm was used to optimize the surgical paths. RESULTS: We defined the vertical compression distance (VCD), a common observation index in clinics. The experiments show that the average VCD of the MPA paths is measured at 23.88 mm, outperforming the clinical planning paths by 21.71 mm. Ablation experiments demonstrated that all three objectives (distance, length, and angle) effectively optimized the path planning. Additionally, we also used finite element analysis to compare and analyze the MPA path and clinical path. The experimental results showed that the MPA path always outperformed the clinical path in terms of scaphoid strain and screw stress. CONCLUSION: This study presents a solution for the path planning of scaphoid fractures. Our future research will attempt to enhance the model's performance and extend its application to a broader range of fracture types.

Vascularized hemi-hamate graft: Anatomic description of a novel pedicled osteo-chondro-ligamentous flap for proximal scaphoid reconstruction.

Scaphoid proximal pole destruction remains a surgical challenge owing to its high propensity for nonunion and osteonecrosis. The hemi-hamate graft has shown promising results in addressing this issue. However, long-term results of non-vascularized composite grafts remain uncertain. The purpose of this study was to investigate the feasibility of a vascularized hemi-hamate osteo-chondro-ligamentous pedicled flap for the reconstruction of the proximal pole of the scaphoid. Thirty fresh cadaveric wrists were used to harvest the hamate proximal pole on the dorsal intercarpal arch. A loss of substance of the scaphoid proximal pole was simulated and the hamate flap was transferred. In 15 wrists, a canulated screw osteosynthesis was performed to assess donor site morbidity and carpus stability on post-osteosynthesis dynamic radiographs. This study suggests that the proximal hamate can be harvested pedicled on the dorsal intercarpal arch. The pedicle (average pedicle diameter 0.9 mm, mean length 31.5 mm) allowed tension-free graft placement in all dissections, except for one. The morphology of the graft was very similar to that of the scaphoid proximal pole and the palmar capito-hamate ligament allowed scapholunate ligament reconstruction in all dissections. This is the first study that describes the use of a pedicled flap to fully reconstruct the complex osteo-chondro-ligamentous anatomy of the scaphoid proximal pole. This vascularized hemi-hamate flap could facilitate better long-term preservation of cartilage biomechanical properties compared to non-vascularized grafts. Donor site morbidity requires further investigation before recommending clinical use.

Evaluating inter- and intraobserver reliability in radiographic determination of wrist alignment following scaphoid excision and four-corner arthrodesis.

Background: Four-corner arthrodesis is commonly performed for advanced collapse patterns of wrist arthritis. Reduction of the capitolunate (CL) angle during four-corner fusion is crucial to allow for the greatest radiocarpal joint arc of motion. Previous studies demonstrate variable inter- and intraobserver reliability of measuring the CL angle. However, in a four-corner fusion, hardware implementation and scaphoid excision can complicate carpal alignment measurements. The purpose of this study is to investigate inter- and intraobserver reliability of measuring carpal alignment parameters following scaphoid excision and four-corner arthrodesis. Methods: Three fellowship-trained orthopaedic hand surgeons evaluated 30 posteroanterior and lateral radiographs of wrists after scaphoid excision and four-corner fusion. Radiographic evaluation included analysis of the radiolunate angle (RL), CL angle, lunate posture, carpal height, carpal height ratio, hardware impingement, and arthrodesis technique. Intraclass correlation coefficients (ICCs) and kappa values were used to evaluate reliability of radiographic measurements. Results: RL and CL angles demonstrated very good inter- (ICCs: 0.657 and 0.693, respectively) and intraobserver agreement (ICCs: 0.576 to 0.924 and 0.596 to 0.811, respectively). Hardware impingement metrics by dorsal prominence and radiocarpal prominence had excellent interobserver reliability of 0.821 and 0.803, respectively. ICC values for arthrodesis technique were equal to 1.00. The inter- and intraobserver ICC values for the number of screws/staples used were in excellent agreement ranging from 0.910 to 1.000. Conclusions: Our study demonstrated favorable intra- and interobserver reliability at assessing carpal alignment following scaphoid excision and four-corner arthrodesis and these metrics potentially could be used in future research to evaluate long-term surgical outcomes. Level of evidence: Level III, retrospective cohort study.

The Impact of Pronator Quadratus Origin Release on the Clinical Outcomes of Scaphoid Nonunion Patients Treated with Pronator Quadratus Pedicled Bone Grafts.

Background/Objectives: A pronator quadratus pedicled bone graft (PQPBG) is a distal radius volar vascularized bone graft used not only for avascular necrosis of the lunate but also for scaphoid nonunion. Despite its potency and its possession of a muscular shield, this vascularized graft has a disadvantage in that the potential shortness of the muscular leash may limit the distal transfer of the bone graft. Releasing of the pronator quadratus (PQ) ulnar origin was used to enhance the distal mobility of the graft. We aimed to investigate the effect of a PQ release on the surgical outcomes of scaphoid nonunions that were operated on with the PQPBG technique. Methods: Patients with scaphoid nonunion that were treated with PQPBG from 2009 to 2020 were reviewed. Patient demographic characteristics, surgical notes, physical examinations, and radiological evaluation data were collected. Wrist range of motion, grip strength, modified Mayo wrist score, and Quick-DASH score were used to evaluate the outcomes. The included patients were divided into two groups based on the origin release status of their PQ, i.e., with and without release. Results: This study included 37 patients, 17 of whom underwent a PQ release and 20 of whom did not. The failure rates for the two groups were one and four patients, respectively, and there was no significant difference between them (p = 0.11). The postoperative mean wrist extension in the patients with a PQ release was significantly greater than that in the patients without a release (43.5 ± 6.8 vs. 36.5 ± 7.7, p = 0.0038). Although wrist flexion, ulnar deviation, radial deviation, mean outcome assessment scores, and grip strength were greater in the patients with a PQ release than in those without, no statistically significant intergroup differences were observed (p > 0.05). Conclusions: The PQPBG technique is a viable option for achieving bony union in patients with scaphoid nonunion, but it results in the postoperative restriction of wrist extension. PQ release during a graft transfer may have a favorable effect on both bone union and clinical outcomes.

Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases.

BACKGROUND: The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. AIMS: The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. METHODS: Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. RESULTS: All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. CONCLUSION: The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.

Graft choice for managing scaphoid non-union: umbrella review.

INTRODUCTION: Since the introduction of the non-vascularized bone graft by Matti and Russe, followed by vascularized grafts and more recently by free vascularized bone grafts, the choice of technique in scaphoid non-union has been controversial. The purpose of the present study was to address the following questions in an umbrella review: Do union rates differ between techniques? Is there any evidence that one technique is superior to another? METHODS: An umbrella review conducted during September 2023 month included systematic reviews and meta-analyses. The primary criterion was mean union rate according to technique. The secondary criterion was indication according to type of non-union. The PubMed, Cochrane, and MEDLINE databases were searched using a predefined methodology according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA version 2020). The quality of the systematic reviews included was evaluated by the "Assessing the Methodological Quality of Systematic Reviews" instrument (AMSTAR 2). RESULTS: Nine studies (systematic reviews or meta-analyses) were included. Quality ranged between low and high. A Table was constructed to summarize the qualitative findings of each article. There was no significant difference in union rates between vascularized and non-vascularized bone grafts in 8 of the 9 studies: vascularized bone graft, 84-92%; non-vascularized bone graft, 80-88%. One study found higher union rates with vascularized bone graft (RR 1.1; 95% CI 1.0-1.2; P = 0.02), but no significant difference in functional results. However, vascularized bone graft was more effective in case of avascular necrosis of the proximal pole (74-88% union for vascularized bone graft vs. 47-62% for non-vascularized bone graft) and in revision cases, while non-vascularized bone graft showed fewer failures in case of humpback deformity and/or dorsal intercalated segment instability (IRR 0.7 ± 0.09; P = 0.01). CONCLUSIONS: This umbrella review provides an overview for management of scaphoid non-union. There were no significant global differences between techniques. Thus, various factors need to be considered when selecting the appropriate technique.

Morphometric indices and carpal tunnel syndrome: a radiological study in female patients.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy syndrome of the upper extremities. The carpal tunnel is an osteofibrous canal that is medially bordered by hamulus ossis hamati and pisiform bone, and laterally by scaphoid and trapezoid bones. In this retrospective case-control study, we investigated the relationship between radiologically measured morphometric indices and CTS in female patients. METHODS: Clinical, radiological, and demographic data were collected for 55 hands of 40 female patients diagnosed with CTS and 58 hands of control subjects. Radiological measurements included various morphometric parameters derived from wrist and hand X-rays. Statistical analysis was conducted to assess associations between morphometric indices and CTS. RESULTS: Significant associations were observed between CTS and several morphometric indices, including carpal height, capitate length, palm length, and others. Notably, these values were lower in CTS patients, suggesting a potential link between reduced carpal tunnel volume and increased pressure due to synovial hypertrophy. Additionally, a newly introduced index, Scaphoid Pisiform Width Index (SPWI), showed promise in assessing the proximal part of the carpal tunnel. CONCLUSION: It was found that the values for Capitate length, Carpal height, Palm length, SPWI, and Palmar ratio were lower in the patient group. These results suggested that decreasing volume of the carpal tunnel allows for an easier increase in carpal tunnel pressure due to increased synovial hypertrophy and the carpal bone configuration affects the proximal part of the carpal tunnel, and influences the compression of the median nerve, in female patients.

Lunate-capitate arthrodesis for scaphoid nonunion: a comparative study.

BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. PATIENTS AND METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. CONCLUSION: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. LEVEL OF EVIDENCE: level IV evidence.

Treatment Selection and Characteristics of Patients With Preiser Disease.

Purpose: Preiser disease is difficult to diagnose and treat because of its unclear pathophysiology. Although both nonsurgical treatment and surgical treatment for Preiser disease have been reported, there is no consensus on the optimal treatment because of its rarity. The purpose of this study was to investigate the relationship between treatment selection and characteristics of patients with Preiser disease. Methods: This single-institution retrospective chart review included nine patients (two men and seven women) with Preiser disease who were treated at our hospital. We divided patients into two groups consisting of elderly (older than 65 years of age) and nonelderly patients. Herbert-Lanzetta classification, presence of dorsal intercalated segment instability (DISI), Watson classification based on plain radiography, Kalainov classification based on magnetic resonance imaging, and treatment modalities were investigated in both groups. Results: In the elderly group, three of five cases were in advanced stages of Preiser disease according to the Herbert-Lanzetta classification. Three wrists had a DISI deformity. Three patients underwent conservative treatment. The two remaining cases classified as Herbert-Lanzetta stage II underwent closing radial wedge osteotomy. In the nonelderly group, three of four cases were in the early stages of Preiser disease according to the Herbert-Lanzetta classification. One wrist had a DISI deformity. Two patients were treated conservatively. The other two patients were surgically treated using closing radial wedge osteotomy in one case and vascularized bone graft from the second metacarpal base in another case, both classified as Herbert-Lanzetta stage II. Conclusions: Most elderly patients with Preiser disease showed concurrent DISI at the time of initial presentation and advanced stage. Most elderly patients underwent nonsurgical treatment. Even when surgical treatment is implemented, our study suggests that the less invasive and optimal treatment is closing radial wedge osteotomy. Type of study/level of evidence: Therapeutic IV.

Distal Scaphoid Excision for Chronic and Nonchronic Scaphoid Fracture Nonunion.

Purpose: The indications for distal scaphoid excision are limited to localized wrist arthritis surrounding the scaphoid, as a result of scaphoid nonunion advanced collapse or scapho-trapezio-trapezoid joint arthritis. The procedure historically has led to relief of symptoms and improvement in strength. Our aim was to examine the outcomes of this procedure in patients with scaphoid fracture nonunion. Methods: This is a single-center retrospective case series of 12 consecutive patients who underwent distal scaphoid excision after scaphoid fracture nonunion. Patients were divided into the following two groups based on nonunion chronicity: chronic (more than a year) and nonchronic (less than a year). Clinical and radiographic data were examined using descriptive statistics. Results: Our cohort consisted of 12 patients, 10 men (83%) and 2 women (17%), with a mean age of 37.6 ± 13.6 years. Eight patients had a chronic scaphoid fracture nonunion (six had a neglected scaphoid fracture and two had a nonunion after scaphoid open reduction and internal fixation with bone graft), and four patients had a nonchronic fracture nonunion (two had failed cast treatment and two had nonunion after scaphoid open reduction and internal fixation with bone graft). Before surgery, all patients complained of pain and four had numbness (all in the chronic group). After an average of 21 weeks after surgery, seven patients (58%) reported continued pain, two patients reported ulnar side pain, and one underwent arthroscopic synovectomy. All patients who started with a normal radiolunate angle continued to have a normal angle, whereas patients who had dorsal intercalated segmental instability prior to surgery persisted with it after surgery, except for a patient who underwent midcarpal fusion and had their radiolunate angle corrected. Conclusions: Distal scaphoid excision is an effective procedure for carefully selected patients with periscaphoid wrist arthrosis. Patients with recent scaphoid fractures that failed treatment may also be treated with distal scaphoid resection. Type of study/level of evidence: Therapeutic V.

Proximal row carpectomy or scaphoid excision and four-corner arthrodesis for treatment of scapholunate advanced collapse arthritis.

Degenerative wrist conditions, such as scapholunate advanced collapse and scaphoid nonunion advanced collapse, often require salvage procedures to reduce pain and improve function. For early stages of disease, both proximal row carpectomy and scaphoid excision four-corner arthrodesis are viable motion-preserving options. There remains controversy on which technique is superior. Selection is a nuanced decision that requires consideration of patient characteristics and stage of disease. The traditional notion that proximal row carpectomy should be reserved for older individuals with low demands has been challenged; long-term studies in younger populations demonstrate similar patient-reported outcomes, pain relief and survivorship without conversion to total wrist arthrodesis between proximal row carpectomy and four-corner arthrodesis. The existing evidence suggests proximal row carpectomy has advantages of greater range of motion, fewer complications and lower costs. Advancements such as arthroscopic techniques for both procedures show potential, although mastery involves a steep learning curve.

A safe zone of dorsal scaphoid approach: an anatomic study of proximal dorsal vessel foramina.

The dorsal approach to the scaphoid carries a risk of injuring its nutrient vessels. This cadaveric study identified a safe zone dorsally, which extends from the proximal pole to 11.3 mm distally along the scaphoid axis.Level of evidence: Level V.