title: A modified Matti-Russe technique of grafting scaphoid non-unions.
abstract: BACKGROUND
  In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated.
  
  
  METHODS
  A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti-Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score.
  
  
  RESULTS
  The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen.
  
  
  CONCLUSIONS
  The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone healing in this study, for patients at risk gadolinium-enhanced MRI scan could be helpful to estimate vascularisation preoperatively. In cases of poor vitality, vascularised bone grafting should be considered.
authors.affiliation: Department for Traumatology, Orthopaedic Surgery and Sportsmedicine, Klinikum am Steinenberg Reutlingen, Steinenbergstrasse 31, 72764, Reutlingen, Germany. dustmann_m@klin-rt.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Dustmann
authors.affiliation: Department for Hand-, Plastic and Microsurgery, Katharinenhospital Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Bajinski
authors.affiliation: Department for Hand-, Plastic and Microsurgery, Katharinenhospital Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tripp
authors.affiliation: Clinik for Traumatology, Hand-, Plastic and Reconstructive Surgery, University of Ulm, Ulm, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Gülke
authors.affiliation: Department for Hand-, Plastic and Microsurgery, Katharinenhospital Stuttgart, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Wachter
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000293:injuries / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Consolidation; Grafting; Matti–Russe; Scaphoid non-union