title: Hybrid Russe Procedure for Scaphoid Waist Fracture Nonunion With Deformity.
abstract: OBJECTIVE
  To assess the results of a hybrid Russe procedure using a corticocancellous strut, cancellous autologous nonvascularized bone graft, and cannulated headless compression screw to reduce the deformity reliably from a collapsed scaphoid nonunion, provide osteoinductive stimulus, and stabilize the fracture for predictable union.
  
  
  METHODS
  A hybrid Russe procedure was performed for scaphoid waist fracture nonunions with humpback deformity and no evidence of avascular necrosis. A volar distal radius autologous bone graft was harvested and a strut of cortical bone was fashioned and placed into the nonunion site to restore length and alignment. We packed cancellous bone graft in the remainder of the nonunion site and fixed the scaphoid was with a headless compression screw. Union was determined by radiographs or computed tomography, and intrascaphoid, scapholunate, and radiolunate angles were calculated on final radiographs. We recorded wrist range of motion, grip strength, pinch strength, pain, and complications.
  
  
  RESULTS
  Fourteen male and 3 female patients (average age, 32 years; range, 16-78 years), with a mean follow-up of 32 months, were examined clinically and radiographically. All 17 scaphoids united with a mean time for union of 3.6 months. The mean postoperative intrascaphoid angle was significantly reduced from 65° preoperatively to 35° postoperatively. The mean radiolunate angle was significantly improved from 20° from neutral (lunate tilted dorsally) preoperatively to 0° postoperatively. The scapholunate angle also demonstrated significant improvement from 70° preoperatively to 56° postoperatively. Grip strength improved from 70% of the contralateral hand to 89% after the procedure. All patients were satisfied with the functional outcome and no donor site morbidity or hardware issues were identified.
  
  
  CONCLUSIONS
  This straightforward hybrid Russe technique predictably restored radiolunate, scapholunate, and intrascaphoid angles with a 100% union incidence. The technique provides excellent functional results in patients with a challenging clinical problem, and we recommend it for scaphoid fracture waist nonunions with dorsal intercalated segment instability deformity.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY. Electronic address: lees@hss.edu.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Byun
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY.
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Roman-Deynes
authors.affiliation: Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY.
authors.forename: Zina
authors.initials: Z
authors.lastname: Model
authors.affiliation: Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Fracture; humpback deformity; modified Russe; nonunion; scaphoid