Ilizarov fixation for the treatment of scaphoid nonunion: a novel approach

Abstract

Objectives: To evaluate the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft. Design: This is a prospective study of 20 consecutive patients in one center. Patients and methods: This study included 20 patients (19 males) with a mean SNU duration of 14.5 months. Four patients had proximal pole, 15 had waist, and 1 had a distal SNU. Patients with carpal instability, humpback deformities, carpal collapse, avascular necrosis, and marked degenerative change were excluded. Following frame application, the treatment comprises three stages: The frame is distracted by 1 mm per day until the radiographs show a 2–3 mm opening at the SNU site (mean 10 days); the SNU site is compressed for 5 days, at a rate of 1 mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the wrist is then immobilized in the Ilizarov fixator for 8 weeks. Results: Radiographic (radiography and CT scan) and clinical bony union was achieved in all 20 patients after a mean of 90.3 days (70–130 days). All patients returned to their pre-injury occupations. Thirteen patients had excellent results, four good, and three fair, according to the Mayo wrist score. Conclusions: In these selected patients, this technique safely achieved bony union without the need to open the SNU site and without the requirement of bone graft. © 2016, Springer-Verlag France.