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Percutaneous Internal Fixation of Selected Scaphoid Nonunions with an Arthroscopically Assisted Dorsal Approach
Joseph F. SladeIII, MD; William B. Geissler, MD; Andrew P. Gutow, MD; Greg A. Merrell, MD
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In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Acumed. Acumed paid travel expenses for one or more of the authors and gave research support related to this work. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Nov 01;85(suppl 4):20-32
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Background: Preliminary reports have indicated that selected scaphoid nonunions—i.e., those that are well aligned and without extensive sclerosis or bone resorption at the nonunion site—can be treated effectively with internal fixation alone. We examined the feasibility of percutaneous fixation in a series of such nonunions.

Methods: A consecutive series of fifteen patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with rigid fixation alone (without bone graft) with a headless compression screw inserted with a dorsal percutaneous technique.

Results: Clinical examination, standard radiographs, and computed tomography scans confirmed union in all patients at an average of fourteen weeks. Nonunions treated less than six months after the injury healed faster than those treated later (p < 0.02). According to the Mayo modified wrist score, there were twelve excellent and three good results.

Conclusions: The results in our series were due to careful examination and grading of the scaphoid nonunions preoperatively. The findings in this small series support the observation in earlier reports that percutaneous repair of selected scaphoid nonunions requires only rigid fixation to achieve healing.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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