Radiologic assessment of arthroscopic correction of humpback deformity in scaphoid fracture non-union

Abstract

Background: Scaphoid non-unions management has two main goals: to achieve bone healing and to restore the normal bone configurations with correction of any deformity. The purpose of the study was To evaluate the degree of correction of humpback deformity arthroscopically in scaphoid fracture non-unions.

Methods: This was a prospective single-center study of twenty patients presented to Alexandria Main University Hospital with non-united fracture scaphoid with humpback deformity in a period from January 2020 to January 2022. The correction of humpback deformity was measured by comparing height to length ratio (H:L ratio), dorsal cortical angle (DCA) and lateral interscaphoid angle (LISA) from sagittal computed tomography images preoperatively and at the final follow-up.

Results: The average follow-up period was 18.75 months. The surgery was performed between 9 to 26 months from injury. Fixation was performed using Kirchner wires in all cases. Seventeen of the twenty non-unions (85%) achieved radiographic union at a mean of 8.7 weeks. H:L ratio decreased from 0.63° (±0.02) to 0.51° (±0.07) (P= 0.0091), DCA increased from 65.4° (±6.07) to 94.35° (±15.3) (P=0.0011) and LISA decreased from 65.4° (±3.26) to 36.45° (±12.04) (P= 0.0012).

Conclusions: Humpback deformity can be corrected arthroscopically without using open techniques. The use of Kirshner wires is sufficient and effective method of fixation that keeps the graft in position and maintains the corrected scaphoid height till achieving union.