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Outcomes Following Scaphoid Non-union Reconstruction
Marianne Williams, PT, CHT; Christine B. Novak, PT, PhD; Herbert P. von Schroeder, MD
University of Toronto, Toronto, ON, Canada

Introduction: Surgical reconstruction following scaphoid non-union is performed using various bone grafts depending on injury factors (such as fracture site location) and specific patient factors. The type of bone graft may influence the duration of postoperative immobilization and ultimately affect hand therapy referral and ultimately outcome. This study evaluated the outcomes following scaphoid reconstruction in patients who attended hand therapy.

Materials & Methods: Following institutional Research Ethics Board approval, we performed a retrospective chart review. Adult patients who underwent scaphoid reconstruction, attended hand therapy at our hospital and were discharged between January 2011 and December 2013 were eligible for inclusion. At initial and final assessment in hand therapy, each patient underwent an assessment which included range of motion, strength and self-report questionnaires. Statistical analyses were performed to evaluate the relationships between the dependent and the independent variables.

Results: There were 26 patients (25 men, 1women) with a mean age of 25 9 years. The mean duration of hand therapy treatment was 4.4 3.2 months. There was a statistically significant improvement in active range of motion (p < 0.001) from intial (extension 33 14.2; flexion 2614.6 degrees) to final (extension 50 13.7; flexion 5416.1degress) post-operative assessment. In those patients (n = 9) who competed the Patient Rated Wrist Evaluation (PRWE), there was a significant improvement (p = 0.007) from initial PRWE (33 19.3) to final PRWE (12 7.2). There was a significant correlational relationship between time from surgery: and initial passive extension (r = .79, p = 0.04); final active flexion (r = .57, p = 0.02). There was no statistical relationship between range of motion and type of graft, dominant hand injured or PRWE scores.

Conclusions: In these patients after scaphoid reconstruction, there was a significant increase in range of motion following hand therapy independent of the bone graft source. We found significant improvement in the self-report questionnaires and range of motion but there was no significant association between those measures. The outcomes of more specific self-report functional gains may be related to the physical impairments and warrants further investigation.

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