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Comparison of Allograft and Autograft in Arthroscopic Bone Grafting for the Treatment of Scaphoid Nonunion
Hui-Kuang Huang, M.D.
Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
IntroductionThis study aims to compare the use of allograft and autograft for arthroscopic bone grafting in the treatment of scaphoid nonunion.
MethodsThis retrospective study evaluated patients with scaphoid nonunion or delayed union lasting more than 3 months after injury, with a minimum follow-up of 1 year between 2014 and 2023. All patients underwent arthroscopic treatment in which bone grafts, either allograft or autograft depending on the patient's decision, were packed into the scaphoid fracture defect. Osteosynthesis was performed using a headless compression screw for fixation. Functional outcomes were assessed using the QuickDASH score, visual analog scale for pain, wrist range of motion, and radiographic parameters including the intrascaphoid angle, scapholunate angle, and radiolunate angle.
ResultsA total of 27 patients in the allograft group, with a mean follow-up of 18.7 months, and 47 patients in the autograft group, with a mean follow-up of 20.4 months, were included in the study. Fracture healing was achieved in 25 patients in the allograft group (92.6%) and in 44 patients in the autograft group (93.6%). Functional outcomes and radiographic parameters significantly improved compared to preoperative status in both groups, with no significant differences between the two groups. However, correction of the humpback deformity and DISI angles were more pronounced in the allograft group. Wrist range of motion was significantly associated with preoperative angles in both groups.
DiscussionIn arthroscopic treatment, minimal injury to the surrounding soft tissue of the scaphoid and the use of a headless compression screw to compress the bone graft are important factors that facilitate healing with either allograft or autograft. In our study, no significant difference in healing rates was found between the two graft types. However, allograft may offer a volume advantage, as it is more readily available for filling bone defects, whereas autograft may sometimes be insufficient in volume when harvested. This may partly explain the less effective correction of radiographic angles for humpback deformity and DISI in the autograft group. Nonetheless, both graft types successfully corrected humpback deformity and DISI to within the normal range, resulting in improved and satisfactory functional outcomes.
ConclusionArthroscopic treatment of scaphoid nonunions using either allograft or autograft can achieve similar and satisfactory healing rates, along with improved functional outcomes. Both methods can improve radiographic parameters related to humpback deformity and DISI correction, with allograft showing better correction than autograft.
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