The Journal of Bone and Joint Surgery, Vol 74, Issue 8 1217-1228, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Long-term results after Russe bone-grafting: the effect of malunion of the scaphoid
WA Jiranek, LK Ruby, LB Millender, MS Bankoff and AH Newberg
New England Medical Center, Boston, Massachusetts 02120.
Twenty-five patients had Russe anterior corticocancellous bone-grafting
between 1973 and 1984 for twenty-six symptomatic established non-unions of
the scaphoid. The mean duration of follow-up was eleven years (range, seven
to eighteen years). Twenty-one (81 per cent) of the twenty-six scaphoid
bones united. We developed two rating scales to evaluate the results of the
operation. One scale, based on objective findings, included the
radiographic appearance of the wrist, the range of motion, and strength;
the other scale, based on subjective findings, comprised function, pain,
perception of a decrease in performance because of limitation of motion or
strength, and satisfaction. These scales were used to compare the objective
and subjective results in patients who had a malunion of the scaphoid in
which the lateral intrascaphoid angle was more than 45 degrees convex
dorsally between the proximal and distal poles (a so-called flexion or
humpback deformity, which results in extension of the proximal fragment of
the scaphoid at the radiocarpal joint) with the results in patients who had
no such deformity. The lateral intrascaphoid angle was more than 45 degrees
in thirteen (50 per cent) of the twenty-six wrists. Although the difference
in the objective results between the wrists that had a malunion and those
that did not have a malunion was highly significant (p = 0.001), there was
no significant difference in the subjective results between the two groups,
including satisfaction of the patient (p = 0.39). Twenty-three patients (92
per cent) returned to full-time employment and twenty-two (88 per cent), to
sports activities. Twenty-three patients (92 per cent) reported that they
had pronounced relief of pain and that the procedure had improved their
quality of life. The presence of this deformity of the scaphoid after
bone-grafting for a symptomatic non-union was not predictive of a poor
long-term subjective outcome.
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