Correlation of Reconstructed Scaphoid Morphology with Clinical Outcomes

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedics, Urmia University of Medical Sciences, Urmia, Iran

2 Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran

3 Department of Orthopedics, Shafa Yahyaian Hospital, Iran University of Medical Sciences, Tehran, Iran

Abstract

 
Background: Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-vascularized bone graft.
Methods: Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes.
Results: There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and Cooney wrist scores in the patients.
Conclusion: In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes.

Keywords


  1. Barton NJ. The late consequences of scaphoid fractures. J Bone Joint Surg Br. 2004; 86(5):626- 30.
  2. Barton NJ. Twenty questions about scaphoid ractures. J Hand Surg Br. 1992; 17(3):289-310.
  3. Megerle K, Harenberg PS, Germann G, Hellmich S. Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury. 2012; 43(3):306-10.
  4. Hung LK. Scaphoid malunion. J Orthop Surg (Hong Kong). 2002; 6(2):104-8.
  5. Capito AE, Higgins JP. Scaphoid overstuffing: the effects of the dimensions of scapoid reconstruction on scapholunate alignment. J Hand Surg Am. 2013; 38(12):2419-25.
  6. Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am. 2012; 37(5):1095-100.
  7. Dias JJ, Singh HP. Displaced fracture of the waist of the scaphoid. J Bone Joint Surg Br. 2011; 93(11):1433-9.
  8. Fisk GR. An overview of injuries of the wrist. Clin Orthop Relat Res.1980; 149(6):137–44.
  9. Lee CH, Lee KH, Lee BG, Kim DY, Choi WS. Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: A 5-year minimum follow-up study. Orthop Traumatol Surg Res. 2015; 101(3):359-63.
  10. Sendher R, Ladd AL. The scaphoid. Orthop Clin North Am. 2013; 44(1):107-20.
  11. ten Berg PW, Dobbe JG, Strackee SD, Streekstra GJ. Quantifying Scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography. J Hand Surg Am. 2015; 40(1):67-73.
  12. Watanabe K. Analysis of carpal malalignment caused by scaphoid nonunion and evaluation of corrective bone graft on carpal alignment. J Hand Surg Am. 2011; 36(1):10-6.
  13. Green DP. The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am. 1985; 10(5):597-605.
  14. Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures; perilunate fracture-dislocation of the wrist. Clin Orthop Relat Res. 1987; 214(3):136–47.
  15. Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney WP 3rd, Linscheid RL. Scaphoid malunion. J Hand Surg Am. 1989; 14(4):679-87.
  16. Fernández DL, Martin CJ, González del Pino J. Scaphoid malunion. The significance of rotational malalignment. J Hand Surg Br. 1998; 23(6):771-5.
  17. Bain GI, Bennett JD, MacDermid JC, Slethaug GP, Richards RS, Roth JH. Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998; 23(1):76-81.
  18. El-Karef EA. Corrective osteotomy for symptomatic scaphoid malunion. Injury. 2005; 36(12):1440-8.
  19. Ring D, Patterson JD, Levitz S, Wang C, Jupiter JB. Both scanning plane and observer affect measurements of scaphoid deformity. J Hand Surg Am. 2005; 30(4):696–701.
  20. Jiranek WA, Ruby LK, Millender LB, Bankoff MS, Newberg AH. Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid. J Bone Joint Surg Am. 1992; 74(8):1217-28.
  21. Forward DP, Singh HP, Dawson S, Davis TR. The clinical outcome of scaphoid fracture malunion at 1 year. J Hand Surg Eur Vol. 2009; 34(1):40–6.