RESUMEN
A vast body of literature emphasizes the use of radiological data for assessing outcomes in scaphoid reconstruction. The goal of this single-center study was to examine patient-reported outcomes and wrist function after scaphoid reconstruction. A total of 162 of 370 patients who underwent scaphoid reconstruction between January 2007 and December 2020 were included in the study. Analyses were conducted using R version 4.0.2 with a significance level at p ≤ 0.05. The clinical follow-up averaged 7.44 years (range 1.03-14.65), with 87% of patients achieving union. The average Disability of the Arm, Shoulder, and Hand (DASH) score was 7.54 (±10.08). The range of motion (ROM) for extension/flexion (E/F) averaged 115.97° (±21.77°) and the grip strength averaged 42.49 kg (±10.78). No statistically significant differences in the parameters studied were observed regarding the occurrence of union. Subgroups of patients without avascular necrosis (AVN), and those with preoperative carpal misalignment and without carpal instability, achieved better functional outcomes with nonvascularized bone grafts compared to vascularized grafts. K-wire fixation resulted in poorer functional outcomes in cases of carpal instability, including ROM in E/F (p = 0.02) and total ROM (p = 0.03), compared to stabilization with compression screw. In patients with AVN (N = 27), neither the type of bone graft nor the osteosynthesis method had any significant effect on functional or patient-reported outcomes. Female patients had higher DASH score (p = 0.03), ROM in E/F (p = 0.04), ROM in ulnar/radial deviation (p = 0.04), ROM in pronation/supination (p = 0.02), and cROM (p = 0.01) than the male patients. More complex reconstruction methods may lead to inferior outcomes and should be reserved for specific indications. The better functional but worse patient-reported outcomes in female patients warrant further analysis.
RESUMEN
Current literature does not definitely demonstrate the superiority of any particular scaphoid reconstruction method. The primary goal of this retrospective single center study was to evaluate the influence of reconstruction techniques and other factors on the union rate after reconstruction of scaphoid nonunions. In the study, 370 patients with nonunions classified as stable (Mayo 1) or unstable (Mayo 2) depending on carpal alignment were included. Minimal radiological follow-up was 3 months. Bone healing after scaphoid reconstruction was evaluated using computer tomography scans in 294 and radiograms in 76 patients. Univariate and multivariate logistic regressions were applied in the analysis. Eight statistically significant factors that influenced the union rate were fixation method, type of previous operations, number of all operations, number of reconstructions, smoking, postoperative pathological lateral intrascaphoid angle (LISA>45°), avascular necrosis (AVN), and stability of nonunion. Smoking and postoperative LISA>45° significantly reduced the probability of bone fusion by approximately 4.4 and 9.5 times, respectively. Patients with reduced vascularity in the nonunion site had a 5.2 times lower chance of bone fusion. Our multivariate logistic regression model can explain 32% of failures after scaphoid reconstruction, including postoperative LISA>45°, patients' present record of smoking, and reduced vascularity in the nonunion site. However, bone graft type does not impact the union rate in general; however, in case of AVN, the tendency toward higher union rates was observed for medial femoral condyle free flaps when compared to other types of graft (non-vascularized and pedicled bone grafts considered as one group, p = 0.09).