Patient-reported outcomes and comprehensive assessment of wrist function after scaphoid reconstruction: A single-center retrospective study on 162 patients.

Abstract

A vast body of literature emphasizes the use of radiological data for assessing outcomes in scaphoid reconstruction. The goal of this single-center study was to examine patient-reported outcomes and wrist function after scaphoid reconstruction. A total of 162 of 370 patients who underwent scaphoid reconstruction between January 2007 and December 2020 were included in the study. Analyses were conducted using R version 4.0.2 with a significance level at p ≤ 0.05. The clinical follow-up averaged 7.44 years (range 1.03-14.65), with 87% of patients achieving union. The average Disability of the Arm, Shoulder, and Hand (DASH) score was 7.54 (±10.08). The range of motion (ROM) for extension/flexion (E/F) averaged 115.97° (±21.77°) and the grip strength averaged 42.49 kg (±10.78). No statistically significant differences in the parameters studied were observed regarding the occurrence of union. Subgroups of patients without avascular necrosis (AVN), and those with preoperative carpal misalignment and without carpal instability, achieved better functional outcomes with nonvascularized bone grafts compared to vascularized grafts. K-wire fixation resulted in poorer functional outcomes in cases of carpal instability, including ROM in E/F (p = 0.02) and total ROM (p = 0.03), compared to stabilization with compression screw. In patients with AVN (N = 27), neither the type of bone graft nor the osteosynthesis method had any significant effect on functional or patient-reported outcomes. Female patients had higher DASH score (p = 0.03), ROM in E/F (p = 0.04), ROM in ulnar/radial deviation (p = 0.04), ROM in pronation/supination (p = 0.02), and cROM (p = 0.01) than the male patients. More complex reconstruction methods may lead to inferior outcomes and should be reserved for specific indications. The better functional but worse patient-reported outcomes in female patients warrant further analysis.