Analysis of Scaphoid Malunion Clinical and Radiographic Outcomes at a Minimum of 4 Years Follow-Up
Anna Seltser, MD1,2; Nina Suh, MD, FRCSC3; Spencer B Chambers, MD4; Joy MacDermid, BScPT, MSc, PhD5; Ruby Grewal, MD, MSc, FRCSC1
1Roth|MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, ON, Canada, 2Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel, 3Roth|MacFarlane Hand and Upper Limb Centre, University of Western Ontario, Roth|MacFarlane Hand and Upper Limb Centre, Canada, London, ON, Canada, 4University of Western Ontario, Roth | McFarlane Hand and Upper Limb Centre, London, ON, Canada, 5Hand and Upper Limb Center, University of Western Ontario, Roth|MacFarlane Hand and Upper Limb Centre, London, ON, Canada
Purpose: To evaluate the radiographic, functional, and clinical outcomes of patients with scaphoid malunion at a minimum of 4 years post-injury.
Methods: Patients with scaphoid malunion were identified from a departmental database created from November 2005 to November 2013, inclusive. Patients with a scaphoid height-to-length ratio (H/L) greater than 0.6 on their final follow-up CT were considered malunited and eligible for inclusion. These patients were contacted to return for CT imaging, clinical assessment, and questionnaires. If unable to return to clinic, patients were invited to complete questionnaires via mail. Twenty-two patients presented for assessment and completed all tests (4 females:18 males). The average age of this group was 41 years (range: 16-64 years), and the average time of follow-up was 7.3 years (range: 4.4-11.8 years) post injury. Nineteen additional patients completed questionnaires by mail (4 females:15 males). The average age of this group was 32 years (range: 16-73 years), and the average time of follow-up was 7.8 years (range: 4.0-11.6 years).
Results: Almost half (45%) of those patients who underwent CT imaging demonstrated arthritic changes at the radial styloid, scaphoid fossa, or scapho-trapezio-trapezoidal joint(s). On clinical exam there was no significant difference between the injured and uninjured wrists in terms of range of motion (flexion p = 0.66, extension p = 0.48, radial deviation p = 0.36, ulnar deviation p = 0.30) or grip strength (p = 0.84). Patient-rated outcome questionnaires did not correlate with scaphoid height-to-length ratio (Average PRWE = 9 (range:0-68), r = 0.54, p=0.1. Average SANE = 90 (range:60-100), r = 0.37, p=0.15. Average EQ-D5 = 6 (range:5-10), r = -0.11, p=0.50. Average WL-25 = 93.7 (range:56-100), r=0.2, p=0.21).
Conclusions: Patients with malunited scaphoid fractures demonstrated radiographic changes compatible with mild early arthritis on CT imaging but overall good clinical results on midterm follow-up.
Type of Study/Level of Evidence: Prognostic IV
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