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Internal Bone Grafting Technique for the Treatment of Scaphoid Non-Unions
Hasan Utkan Aydin, MD; Sunil T. Thirkannad, MD
Christine M Kleinert Institute for Hand and Microsurgery, Louisville, KY

Introduction: Scaphoid fracture is the second most common fracture of the upper extremity after distal radius fractures, and approximately 5%- 10% of undisplaced scaphoid fractures may eventually progress to non-union. The excision of pseudoarthrosis and fibrous scar tissues surrounding the fracture has been so far regarded as one of the important steps in management of scaphoid fractures. We propose a technique where the curettage of the non-union and fibrous tissue was performed through a drill hole on the scaphoid and the bone graft was packed using this drill hole before fixation with a headless compression screw. The aim of this study is to investigate the clinical and radiological outcomes of the internal bone grafting technique performed at our institution.

Materials & Methods: A retrospective chart review was done investigating all patients who presented to the clinic with scaphoid non-unions between 2006 and 2014. Patients with humpback deformity, avascular necrosis, carpal instability and osteoarthritis were excluded.

Results: A total of 14 patients (13 male and 1 female; average age, 37.5 years: range 21-64 years) meeting the set criteria were identified. The average follow up time was 12.2 months (range 2-52 months). Twelve of 14 patients achieved union evidenced by clinical examination and imaging. Two patients demonstrated failure of union (Less than 25% bridging callus on computed tomography scan).

Conclusions: Internal bone grafting is a versatile and technically uncomplicated method, which can be applied successfully in selected cases. This technique allows for the external fibrocartilaginous shell to be preserved, which closely resembles original surface of an uninjured scaphoid.

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