Revisional scaphoid reconstruction for failed screw fixation of scaphoid fractures via the hand trauma plate system.

Abstract

Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation. From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up. We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6-36) months. The mean follow-up period was 43.4 (range, 27-72) months. The mean union time was 11 (range, 8-16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, P = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, P < 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, P < 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, P < 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal. A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.