The Old Scaphoid Fracture Without Avascular Necrosis Treated With Wedge Bone Graft Through Palmar Approach

Fracture of the scaphoid, ranked only second to the distalradius fracture, is the most common type of carpal bone fracture.Because of the special anatomical features of wrist scaphoid,the diagnosis of fracture are easily missed, and the impropertreatment lead to old carpal scaphoid fracture easily. Sincethe emergence of hollow compression screw joint bone graftsurgery, the effect of treatment of old carpal fracture wasimproved.Objective: To discusses and clarify the advantages of thetreatment effect of old carpal fracture without proximalischemic necrosis with the using of palmaris wedge-shape bonegrafting.Method:17cases of old carpal scaphoid fracture withoutproximal ischemic necrosis were treated with Palmariswedge-shape bone grafting from February2007to February2012.14patients were male and the other3patients were female,the average age was31.5. The patients were classified by Herbertype,10cases were C type and7cases were D1type. All thepatients underwent X-ray test and CT scan before operation.All the cases didn’t have proximal ischemic necrosis, from which there were4cases got low-density in local area and3cases got kyphotic deformity. The average duration time frominjured to operation was6months. Fracture healing conditionwas observed by postoperative regularly review X-ray test andthe function of wrist joints was evaluated by Krimmer scoring.Result: The average postoperative follow-up time was23±3.7months. The cases of fracture were bony healing withoutcomplications such as infection, bone ununion, traumaticarthritis and so on. Healing time:13patients’ healing timewas3months,2patients’ healing time was4months,1case’s healing time was5months, and1case’s healing time was6months. According to Krimmer scoring15cases got excellentand the other2cases got good. The wrist flexion and extensionmotion degree was55-165°(average120°±25°)，90%ofuninjured side. The cubit radial partial was25-80°(average61.0°±10.4°)，92%of uninjured side. The grip was25-62kg(average50.0kg±6.7kg)，91%of uninjured side.Conclusion:1) The Palmaris wedge-shape bone grafting combinedwith hollow compression screws internal fixation is suitablefor the old carpal fracture without proximal ischemic necrosiswith kyphosis deformity, and got a better treatment effect.2) For the patients with kyphosis deformity and scaphoid bone nonunion, this procedure can fully show the fracture end, andis easy to identify the scaphoid and bone graft operation.Palmaris incision can expose distal radius at the same time,facilitate take bone, reduce the damage to the scaphoid dorsalblood supply, is conducive to fracture healing, can correctold carpal scaphoid fracture, bone ununion and kyphosisdeformity, and can improve the alignment and length of scaphoidbone.