Scaphoid nonunion special edition

Authors: Marko Bumbaširević

Publish Date: 2016/11/15

Volume: 27, Issue: 1, Pages: 1-2

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Abstract

I am very honored and proud to have been given the opportunity to edit this special edition dedicated to scaphoid nonunion treatment particularly as this edition covers the wide range of operative procedures related to this problem and provides the best solutions for successful nonunion healing I believe that this special edition will provoke immense academic interest among the readers and provide practical knowledge in operative treatment of scaphoid nonunionDuring my career in orthopedic surgery patients with scaphoid bone fractures were always the most complex ones Specific vascularization of scaphoid bone its position influence in wrist biomechanics and unpredictable course and results when healing were always a challenge Over the years scaphoid bone became a mystery and a difficulty for many orthopedic surgeons New techniques in operative treatment surfaced but the results were debatable Some of the old approaches were redefined and modified On the other hand some new ones turned out to be ineffective so the problem remainedOver the years different surgical solutions emerged From simple nonunion sight debridement and fixations bone graft osteoplasty vascularized bone grafts to new solutions that provide successful results even without nonunion sight opening Now we know that the most efficient treatment is one that leads to fracture healing regardless of the technique used Sometimes simple compression with different screws Herbert screw Acutrak screw or even K wires can lead to good results Nonvascularized bone grafts in open reduction and screw fixation were used and still are the most popular procedure for nonunion treatment Arthroscopic approach is frequently used nowadays with cancellous bone graft and percutaneous screw fixation 1 2 3 More sophisticated technique with vascularized bone graft and open reduction and screw fixation seems to be the most efficient when the literature is consulted but it can be technically demanding and only experienced and welltrained surgeons lead to accomplishment 4 5 6Ilizarov technique recently drew attention This new technique has been used successfully in recalcitrant chronic longbone nonunions and it can also be applied in this case It is believed that bony healing is achieved through the application of compression and distraction at the fracture sites which is thought to improve local microcirculation 7 8 9In relation to prognostic factors for successful treatment some authors demonstrated connection between fracture localization and nonunion stability and therefore healing potential If fracture line is located proximal to the apex of scaphoid stability of fracture is good and therefore minimal mobility throughout the time does not lead to nonunion aggravation These types of nonunion have better prognosis 10 Also delay between the initial trauma and the treatment of the established nonunion is significant factor that we have to consider If time elapsed between trauma and treatment is five years or more the possibility for healing is significantly lower 11 12 13Scaphoid nonunion can be sometimes asymptomatic however most patients eventually develop changes in the wrist with consequential pain and limited wrist function with a significant impact on their daily activities Pain and loss of function are due to alterations in wrist biomechanics Further more degenerative disease affects radial styloid area the scaphoradial scaphocapitate and capitolunate joints 15 16 Arthrosis is progressing over time and eventually leads to scaphoid nonunion advanced collapse SNAC dorsal intercalated segment instability with arthrosis in distal scaphoid fragment—radial styloid joint progressing to the scaphocapitate and capitolunate joints 17 18 19 20 21

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