Hybrid Russe Procedure for Scaphoid Waist Fracture Nonunion With Deformity.
PURPOSE
To assess the results of a hybrid Russe procedure using a corticocancellous strut, cancellous autologous nonvascularized bone graft, and cannulated headless compression screw to reduce the deformity reliably from a collapsed scaphoid nonunion, provide osteoinductive stimulus, and stabilize the fracture for predictable union.


METHODS
A hybrid Russe procedure was performed for scaphoid waist fracture nonunions with humpback deformity and no evidence of avascular necrosis. A volar distal radius autologous bone graft was harvested and a strut of cortical bone was fashioned and placed into the nonunion site to restore length and alignment. We packed cancellous bone graft in the remainder of the nonunion site and fixed the scaphoid was with a headless compression screw. Union was determined by radiographs or computed tomography, and intrascaphoid, scapholunate, and radiolunate angles were calculated on final radiographs. We recorded wrist range of motion, grip strength, pinch strength, pain, and complications.


RESULTS
Fourteen male and 3 female patients (average age, 32 years; range, 16-78 years), with a mean follow-up of 32 months, were examined clinically and radiographically. All 17 scaphoids united with a mean time for union of 3.6 months. The mean postoperative intrascaphoid angle was significantly reduced from 65° preoperatively to 35° postoperatively. The mean radiolunate angle was significantly improved from 20° from neutral (lunate tilted dorsally) preoperatively to 0° postoperatively. The scapholunate angle also demonstrated significant improvement from 70° preoperatively to 56° postoperatively. Grip strength improved from 70% of the contralateral hand to 89% after the procedure. All patients were satisfied with the functional outcome and no donor site morbidity or hardware issues were identified.


CONCLUSIONS
This straightforward hybrid Russe technique predictably restored radiolunate, scapholunate, and intrascaphoid angles with a 100% union incidence. The technique provides excellent functional results in patients with a challenging clinical problem, and we recommend it for scaphoid fracture waist nonunions with dorsal intercalated segment instability deformity.


TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
['Lee|Steve K|SK|', 'Byun|David J|DJ|', 'Roman-Deynes|Jorge L|JL|', 'Model|Zina|Z|', 'Wolfe|Scott W|SW|']
D000293:Adolescent D000328:Adult D000368:Aged D001863:Bone Screws D016025:Bone Transplantation D004185:Disability Evaluation D005260:Female D005593:Fracture Fixation, Internal D005599:Fractures, Ununited D018737:Hand Strength D006801:Humans D008297:Male D008875:Middle Aged D010147:Pain Measurement D011183:Postoperative Complications D011859:Radiography D016059:Range of Motion, Articular D021361:Scaphoid Bone D016896:Treatment Outcome D014954:Wrist Injuries
scaphoid Fracture nonunion humpback deformity modified Russe