Long-term Surgical Outcomes of Scaphoid Proximal Pole Fracture Nonunion

• Conditions: Orthopedic

• Registration Number: NCT03701269
• Lead Sponsor: Taipei Veterans General Hospital, Taiwan

Brief Summary

The treatment for scaphoid proximal pole nonunion remains challenging due to the poor vascularity in the proximal pole fragment, associated SL injury and the technique of fixation. Vascularized bone grafts and non-vascularized iliac bone graft have been used in patients with scaphoid proximal pole nonunion, but the indication has not been well clarified. Alternatively, we have been treating such patients with vascularized bone graft , or non-vascularized bone graft with screw or k-wire fixation with considerable success. The purpose of this study is to evaluate and analyze retrospectively the surgical efficacy of our procedure.

Detailed Description

Scaphoid nonunion are common and operative treatment with bone graft was reported to have good result. However, the treatment for proximal pole nonunion remains controversial. There are some patterns of pathoanatomy combined with scaphoid fracture, like SL ligament tears, which could not be easily identified or treated initially. The proximal pole nonunion was near SL joint. Therefore, proximal pole nonunion may result in DISI instability. Furthermore, proximal pole nonunion was identified as a poor prognostic factor in scaphoid nonunion.

In the past 10 years, we have some different technique, like VBG, arthroscopic bone graft to achieve good results. Some studies revealed that significantly better SL stability was achieved with ARASL. We also used ARASL with BG to improve proximal pole union. However, it is not clear which method would be appropriate for proximal pole nonunion. We retrospectively investigated the functional outcome and radiological results after at least 2-year follow-up to clarify the surgical efficacy of these procedures.

Study Timeline

• Study Start: 2018-08-14
• Study First Submitted: 2018-09-26
• Status Verified: 2018-10
• Study First Submitted QC: 2018-10-07
• Last Update Submitted: 2018-10-07
• Study First Posted: 2018-10-10
• Last Update Posted: 2018-10-10
• Primary Completion: 2019-08-13
• Study Completion: 2019-08-13

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 10

Inclusion Criteria

• (1) chronic nonunion (wrist pain for more than 3 months after injury) as defined by preoperative radiographs; and (2) combined positive SL instability measured by intraoperative arthroscopy exam test; (3) Grade I SNAC.

Exclusion Criteria

• (1) skeletally immature patients; (2) previous wrist trauma or surgery.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Disabilities of the Arm, Shoulder, and Hand (DASH) score	averaged 2 years	30-item disability/symptom scale, scored 0 (no disability) to 100

Secondary Outcome Measures

Name	Time	Method
Radiographic examination	averaged 2 years	The union was defined as trabecular bridging across the fracture site

Trial Locations

Locations (1)

Taipei Veterans General Hospital; 🇨🇳 Taipei, Taiwan