Purpose
Rotational instability of scaphoid fracture nonunions can lead to persistent nonunion.
We hypothesized that a hybrid Russe technique would provide improved rotational stability
compared with an instrumented corticocancellous wedge graft in a cadaver model of
scaphoid nonunion.
Methods
A volar wedge osteotomy was created at the scaphoid waist in 16 scaphoids from matched-pair
specimens. A wedge was inset at the osteotomy site or a 4 × 16-mm strut was inserted
in the scaphoid and a screw was placed along the central axis (model 1). The construct
was cyclically loaded in torsion until failure. The screw was removed and the proximal
and distal poles were debrided. A matching wedge and packed cancellous bone graft
or an 8 × 20-mm strut was shaped and fit inside the proximal and distal pole (model
2). A screw was placed and testing was repeated.
Results
In the first model, there was no significant difference in cycles to failure, target
torque, or maximal torque between the strut graft and the wedge graft. Cycles to failure
positively correlated with estimated bone density for the wedge graft, but not for
the strut graft. In the second model, the strut graft had significantly higher cycles
to failure, greater target torque, and higher maximal torque compared with the wedge
graft. The number of cycles to failure was not correlated with estimated bone density
for the wedge or the strut grafts.
Conclusions
The hybrid Russe technique of inlay corticocancellous strut and screw fixation provides
improved rotational stability compared with a wedge graft with screw fixation for
a cadaver model of scaphoid waist nonunion with cystic change.
Clinical relevance
The hybrid Russe technique may provide better rotational stability for scaphoid waist
nonunions when the proximal or distal scaphoid pole is compromised, such as when there
is extensive cystic change, when considerable debridement is necessary, or with revision
nonunion surgery.
Key words
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Article info
Publication history
Published online: July 09, 2020
Accepted:
May 19,
2020
Received:
August 13,
2019
Footnotes
J. D. G. reports non-financial support from Acumed, LLC, related to this study. R. N. K. is an Acumed Consultant. A. L. L. reports financial support from the Ronald and Ann Williams Charitable Foundation. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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© 2020 by the American Society for Surgery of the Hand. All rights reserved.
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