title: Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach.
abstract: BACKGROUND
  Preliminary reports have indicated that selected scaphoid nonunions-i.e., those that are well aligned and without extensive sclerosis or bone resorption at the nonunion site-can be treated effectively with internal fixation alone. We examined the feasibility of percutaneous fixation in a series of such nonunions.
  
  
  METHODS
  A consecutive series of fifteen patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with rigid fixation alone (without bone graft) with a headless compression screw inserted with a dorsal percutaneous technique.
  
  
  RESULTS
  Clinical examination, standard radiographs, and computed tomography scans confirmed union in all patients at an average of fourteen weeks. Nonunions treated less than six months after the injury healed faster than those treated later (p < 0.02). According to the Mayo modified wrist score, there were twelve excellent and three good results.
  
  
  CONCLUSIONS
  The results in our series were due to careful examination and grading of the scaphoid nonunions preoperatively. The findings in this small series support the observation in earlier reports that percutaneous repair of selected scaphoid nonunions requires only rigid fixation to achieve healing.
authors.affiliation: Department of Orthopaedics and Surgery, Yale University School of Medicine, Guilford, CT 06437, USA. joseph.slade@yale.edu
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Slade
authors.forename: William B
authors.initials: WB
authors.lastname: Geissler
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Gutow
authors.forename: Greg A
authors.initials: GA
authors.lastname: Merrell
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*