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Scaphoid Nonunions in Adolescents
Nash Naam, MD1; Abdel Hakim A. Massoud, MD2; Essam El Karef, MD3; Patrick Stewart, MD1; Lisa M. Sasso, MD4; (1)Southern Illinois Hand Center and Southern Illinois University, (2)Al Azhar University, (3)Alexandria Universtiy, Alexandria, Egypt, (4)Southern Illinois Hand Center
Southern Illinois University and Southern Illinois Hand Center, Effingham, IL, USA

Hyposthesis

Scaphoid nonunion is rare in adolescents. Several methods of treatment have been advocated including cast immobilization, Russe bone grafting , vascularized pedicled bone grafts or femoral condyle free vascularized bone grafts. The purpose of this study was to retrospectively evaluate the outcome of treatment of this group of patients. .

Materials and Methods

Between 1995 and 2009, 18 patients, aged 18 or under, were treated for scaphoid nonunions. All patients were males ranging in age from 10 to 18 years. The type of injury was falls in 8 patients, Sports injuries in 6 and unknown in 4. The dominant hand was involved in 9 patients. The site of the fracture was at the waist in 8 patients, the proximal pole in 6 and the distal pole in 4. One patient had previous surgery for percutaneous screw fixation, 9 had cast immobilization and 8 did not have any previous treatment.

Time from injury to surgery averaged 14 months (range 6-17). Nine patients were treated with Russe bone grafting, 8 with vascularized pedicled bone graft using 1,2 ICSRA and one with femoral condyle free vascularized bone graft

Internal fixation was achieved with screw fixation in 15 patients and K wires in 3.

Post operative follow up averaged 4.5 years (2-17). At final follow up patients were evaluated for Pain, functional use, DASH scores, AROM, grip and pinch strength. Radiographic evaluation included assessment of fracture healing, scapholunate angle and any evidence of arthritis.

Results

Seventeen fractures healed. One fracture which was treated with vascularized pedicled bone graft did not heal. There were no complications. Time to healing averaged 14 weeks (7-23). At final follow up, all patients had no pain at rest or with activities. AROM of the wrist averaged 56 ° extension and 63 ° flexion. Grip and pinch strength averaged 85% and 91% of the other side respectively. DASH scores averaged 11 ( 2-23).

Radiographic evaluation confirmed complete bony healing in the 17 patients. CT scan was used in 9 patients to confirm healing. There were no arthritic changes. Scapho lunate angle averaged 56° (41-65°)

Conclusion

Despite the small number of cases, this study demonstrates that Scaphoid nonunions in adolescents can be treated successfully with either Russe bone grafting or vascularized pedicled bone grafts with good functional outcome.

Long term followup is needed to monitor the development of any arthritic changes.


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