Iris Publishers- Open access Journal of Journal of Orthopedics Research | Non-United Fracture Scaphoid Surgery, Simple Step by Step Precise Technique

Authored by Safa Eldin Abaza

For many years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of precise iliac bone graft first described by modified Matti-Russe technique, based on consideration of the three elements of bone healing, deep knowledge of the applied anatomy, vascularity and biomechanics of the carpal bone. We have retrospectively reviewed the results of 69 consecutive patients with nonunion of different sites of the scaphoid treated by one senior author between 2005 and 2018. The objectives of our technique are to apply simple step by step technique that can be utilize by an average orthopedic and hand surgeon starting from simple careful volar soft tissue dissection not to add insult to vasculature, simple reduction, excision of the fibrous none union part of the fracture, preparation and micro fractures of the fracture bed, precise bone graft harvesting, simple fixation and closure. This technique is simple, fast and precise, only used for an established scaphoid nonunion without significant arthritis, chronic non-union with bone cyst formation and may be used in recurrent non-union after failed surgery associated with DISI carpal deformity but no significant radiocarpal or mid carpal arthritis.

McLaughlin 1954 “An unsolved problem”
Barton 1996“Awkward but important little bone”
Little has changed since 1950 still” Awkward but important little bone”
Green Etal “If all bones heal by the same process, why are scaphoid difficult to heal”
1. Failure of timely diagnosis
2. Systemic and local factors
3. Inappropriate treatment.
Bone healing is a complex process requiring mainly on
1. Viable bone cells
2. Continuous bone to bone contact with minimal shears at fracture site
3. Blood supply
Unfortunately the Scaphoid nonunion are lacking all the three elements for union
1. Bindra using microcomputer tomography found “bone trabeculae are more tightly packed and thick at the proximal pole and distal pole In contrast to the waist with the trabeculae are thinnest and sparsely with High numbers of fracture waist and the necessity for a supplement of viable bone cells with highest quality of bone graft.
2. Vascular anatomy: Gleeman in 1980 majority via radial artery 70-80% interosseous vascularity and entire proximal pole from dorsal vessels enter distally and dorsally travel proximally along the dorsal ridge, 20-30% volar radial artery arise from either the artery directly or the superficial palmar branch to enter through the tubercle region, so we do not dissect or violate the dorsal aspect of fracture site and preservation of the superficial palmar branch of the radial artery.
3. In a Comparison of Two Percutaneous Volar Approaches for Screw Fixation of Scaphoid Waist Fractures, Radiographic and Biomechanical Study of an Osteotomy-Simulated Model [1] Figure 1 to 3.
Conclusions: The data suggest that, in a cadaveric osteotomysimulated scaphoid waist fracture model, the transtrapezial approach reliably achieves central positioning of a screw in the proximal and distal poles. This position offers a biomechanical advantage compared with central placement in only the proximal pole, so we use simple K wires fixation and stopped using the screws fixation principle as it is bulky and needs violation of the scaphotrapezial joint with subsequent osteoarthritis Figure 1 to 3.

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