PLATE USING CANCELLOUS GRAFT VERSUS SCREW USING CANCELLOUS CORTICAL GRAFT IN THE TREATMENT OF SCAPHOID PSEUDARTHROSIS

PLACA UTILIZANDO ENXERTO ESPONJOSO VERSUS PARAFUSO UTILIZANDO ENXERTO CÓRTICO ESPONJOSO NO TRATAMENTO DAS PSEUDOARTROSES DO ESCAFÓIDE

ABSTRACT

Objective:  To make a comparative analysis of patients with scaphoid pseudarthrosis operated with screw and corticocancellous graft and patients operated with plate and cancellous graft only, in regards to consolidation, carpal stability and limb functionality.

Methods:  non-randomized retrospective cohort study. Nineteen patients with scaphoid pseudarthrosis without advanced collapse were included in the study, of which 9 patients operated with screw and corticocancellous graft (Group A) and 10 operated with plate using cancellous graft (Group B). The following were evaluated preoperatively and 12 weeks postoperatively: functional recovery using the visual analogue scale, range of motion, grip strength, digital pinch strength, DASH and MAYO wrist score functional scales. To assess carpal instability, the scapholunate and radiolunate angles were assessed on radiographs and the interscaphoid angle on CT. And the bone consolidation rate was assessed with CT in the 8th postoperative week.

Results:  group A with 90% and B with 100% consolidation rate, however the latter with a longer average time for consolidation - 9.7 weeks (p = 0.002). Improvement in pain intensity was achieved in both groups (p = 0.03). Increased pinch strength (p=0.04) and grip strength in group B and decreased in group A. The range of motion was superior in group B, with loss of ulnar deviation (p=0.02) and radial deviation (p=0.007) in group A. Regarding the MAYO wrist score, there was loss of function in group A and an increase in group B (p=0.007). There was correction of the scapholunate angle in both groups (p=0.03), with no difference between them.

Conclusions:  Patients in group B had better recovery of range of motion, pinch and grip strength, and better functionality according to the MAYO wrist score. Level of Evidence III; Study with an Almost-Experimental Design as a Non-Randomized Study with a Single Pre- and Post-Test Group. (Non-Randomized Retrospective Cohort).

Keywords:
Scaphoid Bone; Pseudarthrosis; Bone Plates; Bone Transplantation; Autografts