Document Type : Original Article
Authors
1
Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
2
Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
3
Orthopedic Surgery Department, Damietta Faculty of Medicine, Al-Azhar Univeristy, Egypt
Abstract
Background: The conventional approach for treating scaphoid nonunion involves an open surgical technique to correct deformities, perform bone grafting, and achieve stable internal fixation. Many researchers have recommended percutaneous screw fixation as a treatment for minimally displaced acute scaphoid fractures, and it is now being utilized for displaced scaphoid fractures as well. This study aimed to assess the outcomes of percutaneous headless compression screw fixation combined with bone marrow injection in scaphoid delayed union fractures, facilitating early wrist mobilization to promote a quicker return to activities of daily living [ADL].
Patients and methods: This prospective interventional single arm study included twenty patients with delayed scaphoid fractures who were operated with Dorsal percutaneous screw fixation augmented with bone marrow injection and were assessed clinically and radiologically over 6 months after surgery. The primary outcomes of the study included, time from fracture till operation, pain evaluation which was assessed using the visual analogue scale [VAS], Range of motion, Hand grip, Union rate, and Union time.
Results: In terms of pain assessment, the median VAS significantly decreased from 5 [5 – 6] at baseline, indicating moderate pain, to 0 [0] postoperatively, indicating no pain [P = 0.001]. Range of motion [ROM] was initially limited in all patients, but significantly improved to being limited in only 20% at 6 months postoperatively [P = 0.001]. Hand grip strength improved from weak preoperatively to excellent in 80% of patients at 6 months [P = 0.001]. The study also demonstrated an 80% union rate within a median time of 5.5 months.
Conclusion: The use of bone marrow is considered a simple and minimally invasive technique. There was a significant improvement in pain levels during the follow-up period. There was significant improvement in hand grip evaluation over the course of the follow-up period
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