1. Results of distal radius core decompression and volar percutaneous fixation in scaphoid non-unions without grafting
Süleyman Semih Dedeoğlu,Yunus imren,Haluk Çabuk,Ali Çağrı Tekin,Y.Çağlar Türe,Hakan Gürbüz

2. Background Failure in schaphoid pseudoarthrosis: %20-30
Failure in Matti-Russe procedure: %15-20
Vascularized bone grefting
Bumbasirević MZ, Nonunion--pseudoarthrosis of the scaphoid bone treated with percutaneous fixation, with compression and distraction]. Acta Chir Iugosl. 2008
Munk B, Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion. Acta Orthop Scand. 2004
Hovius SE, de Jong T. Bone Grafts for Scaphoid Nonunion: An Overview. Hand Surg. 2015;20(2):222-7

3. Scaphoid vascularization
Radıal Colon
Effect of radıal core decompressıon
Sherman GM. Core decompression of the distal radius for the treatment of Kienböck's disease: a biomechanical study. J Hand Surg Am. 2008
Illarramendi AA, Radius decompression for treatment of kienböck disease. Tech Hand Up Extrem Surg. 2003

4. Purpose
We aimed to evaluate clinical, radiological, and functional outcomes of distal radial core decompression and fixation with volar percutaneous cannulated compression screws without grafting in patients with scaphoid non-union.

5. Pateints and Methods May 2012 - September 2014
29/32 patients(3 patients out of control)
Fracture till the surgery : 75 weeks ( weeks)
Locaziation: Waist 21, Proximal pole 4, Distal pole 4 patients
Dodds class. N
Type 1 4
Type 2 16
Type 3 7
Type 4 2

6. Surgical Technique
Volar percuteneous fixation 3.5 mm headless cannulated compression screw
Dorsal incision over distal metaphysis of the radius(a window of 0.5 cm x 0.5 cm and 2 cm proximal to radius styloid was created with small osteotomes)
Short arm cast(8-10 weeks)

7. Results Follow-up was 76 weeks (74-87 weeks).
Time for union was 11 weeks (7-18 weeks)
26/29 union (89%)
All non-union was seen in proximal pole fractures

8. Results Pre-operative Post-operative Mean SD p value VAS 7.18 1.10
2.15
2.06
0.03
Mayo-wrist score
36.25
17.27
66.25
20.93
0.02
Flexion
47.5
8.94
61.5
14.6
0.005
Extansion
45.62
8.73
61.25
15.75
0.00

9. Conclusions
Percutaneous fixation through volar approach without bone grafting together with core decompression of distal radius is a good and easy treatment option for the surgical management of scaphoid non- unions

10. THANK YOU FOR YOUR ATTENTİON