Hook of the hamate fractures are frequently underdiagnosed and prone to symptomatic non-union. Internal fixation preserves carpal stability and grip strength. We describe a percutaneous antegrade technique for a stable osteosynthesis.
Hook of the hamate fractures are frequently underdiagnosed and prone to symptomatic non-union. Internal fixation preserves carpal stability and grip strength. We describe a percutaneous antegrade technique for a stable osteosynthesis.
Introduction: This study aims to assess the rates of return to work and sports participation following arthroscopic bone grafting for severe scaphoid nonunion.
Patients and methods: We conducted a retrospective analysis of patients treated for scaphoid nonunion from 2017 to 2024, with a minimum follow-up of one year. All patients underwent arthroscopic repair utilizing an olecranon bone graft and antegrade screw fixation. Employment status and sports participation prior to the diagnosis of nonunion were documented and evaluated at final follow-up.
Results: A total of 21 patients met the inclusion criteria. Before the diagnosis of scaphoid nonunion, 18 patients (85.7%) were employed, with 2 (11.1%) not returning to work. Seventeen patients (80.9%) participated in sports prior to nonunion. At the final follow-up, one patient (5.8%) was unable to resume sports, while two patients (11.7%) modified their activities due to ongoing wrist discomfort during pre-injury sports.
Conclusion: The arthroscopic management of scaphoid nonunion resulted in significant functional recovery, with an 88.9% return-to-work rate and a 94.2% return-to-sport rate.
Level of evidence: IV.
Achieving tension-free end-to-end sutures is crucial for optimal nerve recovery; however, it presents significant challenges in the contralateral C7 nerve transfer (cC7 transfer) procedure for patients with hemiplegic arms. This paper presents a modified surgical technique for cC7 transfer, featuring an aesthetically pleasing incision design. Key steps of the technique include precise incision planning, careful exposure and identification of the brachial plexus, meticulous tracing of the cC7 nerve, protection of the phrenic nerve and vertebral vessels, and the creation of a prevertebral space to facilitate the nerve transfer. We illustrate this method step by step in a hemiplegic patient. In conclusion, our approach offers a safe and effective strategy for performing modified contralateral C7 transfer surgery, ensuring tension-free end-to-end sutures for improved patient outcomes.
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