The clinical implication of a residual flexion deformity following surgery for scaphoid nonunion is unclear. Sixty-three patients who underwent scaphoid nonunion surgery were assessed after a mean of 7 years (range 5–10) to analyse the outcomes based on the presence of residual scaphoid deformity. Primary outcome was Disabilities of the Arm, Shoulder and Hand score. Secondary outcomes were Patient-Rated Wrist Evaluation score, wrist range of motion and strength. Patients were dichotomized to residual deformity or no deformity. Scaphoid deformity was calculated from CT scans based on the median difference between the height–length ratio of the operated versus the uninjured scaphoid. There were no differences between residual deformity (n = 33) and no deformity (n = 30) in any outcome variables, except for wrist extension which was slightly worse in the deformity group. The deformity group had a greater number of radiographic osteoarthritis, but all cases were mild, and osteoarthritis did not correlate to a worse outcome. We conclude that residual scaphoid deformity has no relevant negative impact on mid-term wrist function.
AfsharAMohammadiAZohrabiKNavaeifarNSamiSHTalebH.Correlation of reconstructed scaphoid morphology with clinical outcomes.Arch Bone Jt Surg. 2015,
3: 244–9.
2.
BainGIBennettJDMacDermidJCSlethaugGPRichardsRSRothJH.Measurement of the scaphoid humpback deformity using longitudinal computed tomography: intra- and interobserver variability using various measurement techniques. J Hand Surg Am. 1998,
23: 76–81.
3.
BurgessRC.The effect of a simulated scaphoid malunion on wrist motion. J Hand Surg Am. 1987,
12: 774–6.
4.
ChambersSBPadmoreCEFanSGrewalRJohnsonJSuhN.The impact of scaphoid malunion on carpal motion: an in-vitro analysis. J Hand Surg Asian Pac. 2021,
26: 396–402.
5.
ClayNRDiasJJCostiganPSGreggPJBartonNJ.Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br. 1991,
73: 828–32.
6.
CooneyWPLinscheidRLDobynsJHThe wrist diagnosis and operative treatment. 1st Edn. St. Louis, MO, Mosby, 1998.
7.
DiasJJBrenkelIJFinlayDB.Patterns of union in fractures of the waist of the scaphoid. J Bone Joint Surg Br. 1989,
71: 307–10.
8.
DiasJJBrealeySDFairhurstC, et al.
Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT): a pragmatic, multicentre, open-label, randomised superiority trial. Lancet. 2020,
396: 390–401.
9.
El-KarefEA.Corrective osteotomy for symptomatic scaphoid malunion. Injury. 2005,
36: 1440–8.
10.
ForwardDPSinghHPDawsonSDavisTR.The clinical outcome of scaphoid fracture malunion at 1 year.J Hand Surg Eur. 2009,
34: 40–6.
11.
FranchignoniFVercelliSGiordanoASartorioFBraviniEFerrieroG.Minimal clinically important difference of the disabilities of the arm, shoulder, and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. 2014,
44: 30–9.
12.
GaralaKTaubNADiasJJ.The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J. 2016,
98-B: 654–9.
13.
GuldbrandsenCWRadevDIGvozdenovicR.Normal ranges for measurements of the scaphoid bone from sagittal computed tomography images. J Hand Surg Eur. 2021,
46: 594–9.
14.
HudakPLAmadioPCBombardierC.Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG).Am J Ind Med. 1996,
29: 602–8. Erratum in: Am J Ind Med. 1996, 30: 372.
15.
JiranekWARubyLKMillenderLBBankoffMSNewbergAH.Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid.J Bone Joint Surg Am. 1992,
74: 1217–28.
16.
KimJHLeeKHLeeBGLeeCHKimSJChoiWS.Dorsal intercalated segmental instability associated with malunion of a reconstructed scaphoid. J Hand Surg Eur. 2017,
42: 240–5.
17.
LeeCHLeeKHLeeBGKimDYChoiWS.Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: a 5-year minimum follow-up study. Orthop Traumatol Surg Res. 2015,
101: 359–63.
18.
LindströmGNyströmA.Natural history of scaphoid non-union, with special reference to “asymptomatic” cases.J Hand Surg Br. 1992,
17: 697–700.
19.
LynchNMLinscheidRL.Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation. J Hand Surg Am. 1997,
22: 35–43.
20.
MacDermidJCTurgeonTRichardsRSBeadleMRothJH.Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998,
12: 577–86.
21.
MegerleKHarenbergPSGermannGHellmichS.Scaphoid morphology and clinical outcomes in scaphoid reconstructions. Injury. 2012;
43: 306–10.
22.
RingDPattersonJDLevitzSWangCJupiterJB.Both scanning plane and observer affect measurements of scaphoid deformity. J Hand Surg Am. 2005,
30: 696–701.
23.
SeltserASuhNMacDermidJCGrewalR.The natural history of scaphoid fracture malunion: a scoping review. J Wrist Surg. 2020,
9: 170–6.
24.
SorensenAAHowardDTanWHKetchersidJCalfeeRP.Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am. 2013,
38: 641–9.
25.
SwärdEMSchrieverTUFrankoMABjörkmanACWilckeMK.The epidemiology of scaphoid fractures in Sweden: a nationwide registry study. J Hand Surg Eur. 2019,
44: 697–701.
26.
TangJBGiddinsG.Why and how to report surgeons' levels of expertise. J Hand Surg Eur. 2016,
41: 365–6.
27.
ten BergPWDobbeJGStrackeeSDStreekstraGJ.Three-dimensional assessment of bilateral symmetry of the scaphoid: an anatomic study. Biomed Res Int. 2015a,
2015: 547250.
28.
ten BergPWDobbeJGStrackeeSDStreekstraGJ.Quantifying scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography. J Hand Surg Am. 2015b,
40: 67–73.
29.
WatsonHKBalletFL.The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984,
9: 358–65.
30.
XiaoMWelchJMCohenSAKamalRNShapiroLM.How is scaphoid malunion defined: a systematic review. Hand (NY). 2021,
5: 15589447211038678.
