title: Percutaneous screw fixation without bone grafting of scaphoid non-union.
abstract: BACKGROUND
  Delays in diagnosis and inadequate treatment of acute scaphoid fractures can lead to non-unions, presenting surgeons with unique challenges regarding optimal management.
  
  
  OBJECTIVE
  To evaluate the clinical and radiographic outcome of scaphoid non-unions treated with percutaneous screw fixation.
  
  
  METHODS
  The study group comprised 12 patients with scaphoid non-unions of an average duration of 8.7 months. There were 11 males and 1 female with an average age of 24 years (range 14-47 years). All patients were initially treated with percutaneous screw fixation without bone grafting. A volar percutaneous approach was used in eight patients and a dorsal percutaneous approach in four. Wrist range of motion (ROM) and disabilities of the arm, shoulder, and hand (DASH) questionnaires were used to assess clinical outcomes. Postoperative radiographs were reviewed to assess the fracture union, carpal alignment and screw position.
  
  
  RESULTS
  Eleven of the 12 (92%) fractures united successfully with no additional procedures. These fractures achieved radiographic union at an average of 4 months. One patient with sickle cell anemia required revision fixation, which consisted of repeat percutaneous fixation and bone grafting. In this patient his non-union healed 3 months after the revision procedure. The average DASH score at final followup was 6 (range 0-16). Average wrist ROM was extension of 66 degrees (range 50-80) and flexion 71 degrees (range 55-90). None of the patients showed radiographic signs of osteoarthritis, osteonecrosis of the scaphoid, or hardware-related complications.
  
  
  CONCLUSIONS
  For scaphoid waist non-unions without collapse, percutaneous fixation without supplementary bone grafting provides satisfactory results with a high union rate, early return of function and minimal complications.
authors: Department of Orthopedics, Division of Hand Surgery, New York University-Hospital for Joint Diseases, New York, NY, USA. John.Capo@nyumc.org
authors: John T
authors: JT
authors: Capo
authors: Ben
authors: B
authors: Shamian
authors: Marco
authors: M
authors: Rizzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries* / Q000601:surgery; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult