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DiPrinzio EV, Dieterich JD, Walsh AL, Warburton AJ, Chang AL, Hausman MR, Kim JM. Two Parallel Headless Compression Screws for Scaphoid Fractures: Radiographic Analysis and Preliminary Outcome. Hand (N Y) 2023; 18:1267-1274. [PMID: 35403458 PMCID: PMC10617477 DOI: 10.1177/15589447221081879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite surgical fixation, the scaphoid nonunion rate remains at 3% to 5%. Recent biomechanical studies have demonstrated increased stability with 2-screw constructs. The objective of our study is to determine the preliminary union rate and anatomic feasibility of 2-screw surgical fixation for scaphoid fractures. METHODS This study is a retrospective case series of 25 patients (average age 32 years) with scaphoid fractures treated with 2 parallel headless compression screws (HCS). Postoperative evaluation included Mayo Wrist Score (MWS), range of motion, time to union, and return to activity. Bivariate analysis for gender and Pearson correlation coefficient for body size (height, weight, and body mass index) was conducted against radiographically measured scaphoid width, screw lengths, and the distance between the 2 screws. RESULTS All fractures healed with an average time to union of 9.9 weeks (median 7.6 weeks; range: 4.1-28.3). The mean MWS was 93.3 (range: 55-100), with 3 complications (12%), one of which affected the outcome of the surgery. The bivariate analysis demonstrated that the female gender was associated with significantly smaller scaphoid width (P = .004) but a similar distance between the 2 screws (P = .281). The distance between the 2 screws and the body size demonstrated a weak-to-no correlation. CONCLUSIONS The 2-screw construct for scaphoid fracture achieved a favorable union rate and clinical outcome. Gender was the only variable significantly associated with scaphoid width and screw length. The distance between the screws was constant regardless of gender and body size, indicating that the technique for parallel screw placement can remain consistent. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | | | - Andy L. Chang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jaehon M. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wataya EY, Meneghel GH, Mores V, Nakamoto JC, Xavier RM, Junior RM. Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate. Arch Orthop Trauma Surg 2023; 143:6955-6963. [PMID: 37526738 DOI: 10.1007/s00402-023-05003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Scaphoid is the most fractured carpal bone, with a 5-10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing. OBJECTIVE Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery. METHODS Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation. RESULTS In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups. CONCLUSION Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Erick Yoshio Wataya
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Guilherme Henrique Meneghel
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil.
| | - Victor Mores
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | | | - Renato Martins Xavier
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Rames Mattar Junior
- Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil
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Liau CJ, Liew SK, Arsad SR, Muhammad Nawawi RF, Silvanathan JP. Scaphoid Plate Osteosynthesis in Complex Fractures and Wrist Trauma: A Case Series. Cureus 2023; 15:e45067. [PMID: 37842372 PMCID: PMC10568241 DOI: 10.7759/cureus.45067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Treatment of scaphoid fracture is challenging due to its unique blood supply and geometry. Traditionally, a headless compression screw is the standard treatment for unstable scaphoid fracture. Some fractures are complex, for example, comminution with bone loss. A scaphoid plate is an option in these difficult fractures providing adequate rotational stability. Aim To share our experience in using scaphoid plates in complex wrist trauma and comminuted fractures. Method and material Complex wrist trauma involving scaphoid fractures that were comminuted and multi-fragmentary fractures treated with plate osteosynthesis were retrospectively reviewed between July 2019 and September 2021. Patient demographic data, preoperative radiographs, CT scans, pain, wrist range of motion, and fracture union rate to union were reviewed. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH®) score was recorded at 1-year postoperative follow-up. Results Nine patients associated with complex wrist trauma were included in this case series. The mean follow-up was 2.5 years (13-30 months). The union rate was 100%. The mean arc of motion was 105° (95-110°). QuickDASH® score was 19.96 at 1-year postoperative follow-up. Four patients had good outcomes, four satisfactory, and one poor outcome. One hardware complication was observed which was the impingement of the plate proximally over the articular surface of the distal radius. Conclusion A scaphoid plate is a reliable option for treating complex and difficult fractures. It provides adequate stability, especially in comminution, bone loss, or multi-fragmentary fractures which are not amendable using other fixation methods. We recommend the expansion of plate osteosynthesis beyond scaphoid nonunion into complex wrist trauma.
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Affiliation(s)
- Chai Jiun Liau
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Selayang, Selangor, MYS
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Siew Khei Liew
- Hand & Microsurgery Unit, Orthopedics Department, University Putra Malaysia, Selangor, MYS
| | - Syahril Rizal Arsad
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Selayang, Selangor, MYS
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Schäfer RC, Nusche A, Einzmann A, Illg C, Daigeler A, Rachunek K. The corticocancellous press fit iliac crest bone dowel for recalcitrant scaphoid nonunion: analysis of union rate and clinical outcome. Arch Orthop Trauma Surg 2023; 143:6001-6010. [PMID: 37012506 PMCID: PMC10449721 DOI: 10.1007/s00402-023-04846-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Scaphoid nonunion after failed primary treatment remains challenging particularly when entailed by bone loss, avascular necrosis or deformity. We describe a scaphoid augmentation and fixation technique for cases of recalcitrant nonunion after screw placement by autologous press fit corticocancellous dowel. This study aims to provide reliable data on clinical and radiological outcomes and to contextualize in the face of other treatment options. MATERIAL AND METHODS The study included 16 patients with recalcitrant nonunion of the scaphoid. All patients received screw removal and scaphoid reconstruction by a dowel shaped non-vascularized corticocancellous bone graft from the iliac crest facilitating packing of the screw channel. Bone union, the scapholunate, radiolunate and intrascaphoidal angles were evaluated on X-ray and CT images, range of motion noted. Additionally grip strength, DASH and Green O'Brien scores were obtained from eight patients. RESULTS A union rate of 73% was noted after mean follow-up of 54 months. After revisional reconstruction of the scaphoid an extension-flexion rate of 84% of the healthy side was noted while pronation-supination reached 101%. DASH score averaged at 2.9, rest pain on a numeric rating scale was 0.43 with 99% peak grip force of the healthy side. CONCLUSION In complex cases of revisional scaphoid nonunion after screw placement, the corticocancellous iliac crest pressfit dowel is an option for augmentation and stabilization of the scaphoid by preserving the articular surface. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Ruth Christine Schäfer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
| | - Andreas Nusche
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Anna Einzmann
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Claudius Illg
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany
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Quadlbauer S, Pezzei C, Jurkowitsch J, Beer T, Moser V, Rosenauer R, Salminger S, Hausner T, Leixnering M. Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperative extracorporeal shockwave therapy (ESWT). Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04806-0. [PMID: 36808564 DOI: 10.1007/s00402-023-04806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. MATERIALS AND METHODS Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41 mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. RESULTS Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant. However, at a mean follow-up interval of 34 months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. CONCLUSIONS Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - V Moser
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S Salminger
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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Manako T, Imade S, Yamagami N, Yamamoto S, Uchio Y. The clinical outcomes of scaphoid nonunion treated with a precisely processed autologous bone screw: a case series. Arch Orthop Trauma Surg 2023; 143:627-635. [PMID: 34347123 DOI: 10.1007/s00402-021-04092-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Metal implants and bioabsorbable implants are frequently used in orthopaedic surgery, but they have some disadvantages. The usefulness of autologous bone has been described, and a method to precisely process autologous bone into implants such as screws and apply the implants clinically has been desired. We created a new system for manufacturing autologous bone screws during surgery and report five cases of scaphoid nonunion treated with precise autologous bone screws made from the tibial cortex using the new system. PATIENTS AND METHODS From 2012 through 2017, seven patients were diagnosed with scaphoid nonunion at our hospital and based on the inclusion/exclusion criteria, five of them were analyzed herein. The surgery was performed according to Zaidemberg's technique. The bone screw in each case was made from autologous tibial cortex using a numerically controlled lathe (model MTS4, Nano Co., Yokohama, Japan) under sterile conditions. The change in each patient's modified Mayo wrist score between the preoperative examination and at the final survey was determined, as were complications. RESULTS The median modified Mayo wrist score improved significantly from 65 to 95 points. All patients who were followed for > 2 years fused at a median duration of 3.5 months. Bone regeneration was confirmed at the donor sites in all cases. One fracture at the donor site occurred as a severe complication. CONCLUSIONS Precisely shaped autologous bone screws manufactured by a computer-assisted machine, together with a vascularized bone graft, may be a useful technique for treating scaphoid nonunions; these screws had good stability and bone replacement. Careful observation of the donor site is required. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Takuya Manako
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan.
| | - Shinji Imade
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Nobuo Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Soichiro Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
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Cheng C, Jiang Z, Sun H, Hu J, Ouyang Y. Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft. J Orthop Surg Res 2023; 18:52. [PMID: 36653796 PMCID: PMC9847075 DOI: 10.1186/s13018-023-03529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment. PURPOSE This study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes. METHODS It was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period. RESULTS Significant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients. CONCLUSIONS The arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.
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Affiliation(s)
- Cong Cheng
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Zongyuan Jiang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Haoran Sun
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Jiaping Hu
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Yanggang Ouyang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
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Ma W, Yao J, Guo Y. Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases. Front Surg 2023; 10:1096684. [PMID: 36874466 PMCID: PMC9982011 DOI: 10.3389/fsurg.2023.1096684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose This study reports the clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions. Patients and methods This study was a retrospective survey. From January 2018 to December 2019, 21 patients with displaced scaphoid fractures underwent open debridement and two headless compression screw fixation with bone grafting. The preoperative and postoperative lateral intrascaphoid angle (LISA) and scapholunate angle (SLA) were recorded. Preoperative and postoperative grip strength (% of the healthy side), active range of motion (AROM), visual analogue scale (VAS), and patient-rated wrist evaluation (PRWE) scores at the final follow-up were obtained for all patients for comparison. Results Patients were treated for an average of 38.3 months (range 12-250) after the injury. The average time of postoperative follow-up was 30.5 months (range 24-48). All fractures achieved union at a mean of 2.7 months (range 2-4) after surgery, and 14 scaphoids of 21 patients (66.7%) healed by 8 weeks. CT scans showed no evidence of cortical penetration of either screw in all patients. There was a statistically significant improvement in AROM, grip strength, and PRWE. No complications occurred in this study, and all patients returned to work. Conclusion This study indicates that double-screw fixation with bone grafting is an effective technique for treating displaced scaphoid nonunions.
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Affiliation(s)
- Wei Ma
- Department of Orthopedic Surgery, Air Force Medical Center, Beijing, China
| | - Jeffrey Yao
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA, United States
| | - Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, The Fourth Clinical College of Peking University, Beijing, China
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Surke C, Huntington LS, Zhang X, Ek ETH, Ackland D, Tham SK. Double-Screw Osteosynthesis in an Unstable Scaphoid Fracture Model: A Biomechanical Comparison of Two Screw Configurations. J Hand Surg Am 2022; 47:1118.e1-1118.e8. [PMID: 34690014 DOI: 10.1016/j.jhsa.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/28/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Although there is evidence that a single headless compression screw is sufficient for fixation of most scaphoid fractures, double-screw osteosynthesis has been shown to result in higher failure strength and stiffness than a single screw. However, the biomechanical effect of different screw configurations has not been determined. METHODS A standardized unstable fracture model was produced in 28 cadaveric scaphoids. Specimens were randomly allocated to 1 of 2 fixation groups using 2 internal compression screws positioned in either the sagittal or coronal plane. A specimen-specific 3-dimensionally-printed customized screw placement and osteotomy device was developed using computer-aided design-generated models derived from computed tomography scan data of each individual scaphoid. Load to failure and stiffness of the repair constructs were evaluated using a mechanical testing system. RESULTS There were no significant differences in size, weight, and density between the scaphoid specimens. The average distance between screws was significantly greater in the sagittal group than in the coronal group. There were no significant differences between the coronal and sagittal aligned double screws in load to 2 mm displacement (mean coronal 180.9 ± 109.7 N; mean sagittal 156.0 ± 85.8 N), load to failure (mean coronal 275.9 ± 150.6 N; mean sagittal 248.0 ± 109.5 N), stiffness (mean coronal 111.7 ± 67.3 N/mm; mean sagittal 101.2 ± 45.1 N/mm), and energy absorption (mean coronal 472.6 ± 261.4 mJ; mean sagittal 443.5 ± 272.7 mJ). CONCLUSIONS There are no significant biomechanical differences between the sagittal or coronal aligned double headless compression screws in a scaphoid fracture model with bone loss. CLINICAL RELEVANCE In cases where double-screw fixation of the scaphoid is being considered, the placement of double screws can be at the discretion of the surgeon, and can be dictated by ease of access, surgical preference, and fracture orientation.
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Affiliation(s)
- Carsten Surke
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, University of Bern, Switzerland; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - Lachlan S Huntington
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Xin Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Eugene T H Ek
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - David Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen K Tham
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Department of Plastic and Hand Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia.
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Abstract
The scaphoid is predisposed to nonunion after fracture because of its tenuous blood supply and propensity for delayed diagnosis. Many surgical techniques exist and continue to be developed to treat scaphoid non-unions. However, with variability in patient presentation, differences in nonunion location and type, and multiple bone graft sources and fixation options, selecting a surgical strategy proves a difficult task. The goal of this article is to provide an updated review of surgical strategies used to treat scaphoid nonunions. Particular attention is paid to methods of fixation as well as the ongoing debate over indications for structural and vascularized bone grafting. [Orthopedics. 2022;45(5):e235-e242.].
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de Menezes AB, Back CGN, Driusso P, Liebano RE. How to report parameters and procedures for shockwave therapy in musculoskeletal disorders: A narrative review. Medicine (Baltimore) 2022; 101:e29664. [PMID: 35960087 PMCID: PMC9371498 DOI: 10.1097/md.0000000000029664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Shockwave therapy (SWT) has been successful in the management of musculoskeletal conditions. The limitations of the use of SWT in clinical practice regard a lack of familiarity with the device and the lack of uniformity in information reported in scientific publications. Standardization in the reporting of these parameters could facilitate the reproduction and interpretation of data in future studies. Most studies fail to offer a detailed description of the parameters. Therefore, the aim of the present paper is to prepare a report on how to standardize the presentation of this information and serve a reference guide to report physical parameters and procedures of SWT when used on patients with musculoskeletal disorders. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. SWT parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, the description of patient and equipment positioning was added. The consensus-based guideline on how to report SWT parameters for the treatment of musculoskeletal conditions was developed to help clinicians and researchers.
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Affiliation(s)
- Athilas Braga de Menezes
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
- *Correspondence: Athilas Braga de Menezes, Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), WA Luiz highway, São Carlos, Brazil (e-mail: )
| | - Cláudio Gregório Nuerberg Back
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
| | - Patricia Driusso
- Women’s health Research Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), Brazil
| | - Richard Eloin Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of Sao Carlos (UFSCar), Brazil
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12
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Leti Acciaro A, Lana D, Fagetti A, Cherubino M, Adani R. Plate fixation in challenging traumatic carpal scaphoid lesions. Musculoskelet Surg 2022; 106:179-185. [PMID: 33393002 DOI: 10.1007/s12306-020-00689-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Complex fractures of the carpal scaphoid with poles fragmentation, edges comminution, bone loss and non-union of fractures previously treated by screw fixation remain challenging for hand surgeons. The authors present the indications, advantages and results of scaphoid plating, underlining the importance of correct plate positioning well shaped onto the bone. MATERIALS AND METHODS The study includes 11 patients presenting acute fracture with distal pole fragmentation, acute fracture with comminution and non-union after prior failure of screw fixation. All patients were treated with volar locked plate fixation, adding a cortical bone graft in cases of non-union. RESULTS Bone consolidation was achieved in all cases; excellent outcomes in fracture healing and relevant improvement in symptoms and functions were obtained in non-union group that are consistent with the literature. Only one patient underwent early further surgery (first row carpectomy) with poor results. CONCLUSION The treatment of the selected scaphoid lesions with volar locked plate is a surely efficient technique. The plate can be easily adjusted to the shape of the scaphoid and can achieve an adequate correction of bone deformity and high degree of stability both in non-union and fractures.
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Affiliation(s)
- A Leti Acciaro
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
| | - D Lana
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy.
| | - A Fagetti
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - M Cherubino
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - R Adani
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
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13
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Shapiro LM, Roe AK, Kamal RN. Clinical and Patient-Reported Outcomes After Hybrid Russe Procedure for Scaphoid Nonunion. Hand (N Y) 2022; 17:13-22. [PMID: 32188288 PMCID: PMC8721791 DOI: 10.1177/1558944720911214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Hybrid Russe technique for the treatment of scaphoid nonunion with humpback deformity has been described with a reported 100% union rate. We sought to evaluate the reproducibility of this technique. Methods: We completed a retrospective chart review of patients with a scaphoid waist nonunion and humpback deformity treated with the hybrid Russe technique from 2015 to 2019 with a minimum of 3-month follow-up. Twenty patients with 21 nonunions were included (mean follow-up: 7.0 months). Scapholunate angle was the primary outcome measure. Secondary outcomes included: intrascaphoid angle, radiolunate angle, pain on the visual analog scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Other variables included: time to computed tomography (CT) union, range of motion, and complications. Descriptive statistics were presented. Pre- and postoperative angles, VAS, and QuickDASH scores were evaluated with Wilcoxon signed rank tests. Results: The mean scapholunate angle improved -17.6° ± 6.4°. The mean intrascaphoid angle improved 28.2° ± 6.3°. The mean radiolunate angle improved 12.8° ± 8.8°. Of the 21 scaphoids, 20 (95%) demonstrated union on a CT scan. One patient was diagnosed with a nonunion. In total, 90% of patients noted symmetric range of motion compared with the contralateral side. The mean VAS pain score improved 6 ± 3 points. The mean QuickDASH score improved 10 ± 8 points. Complications (aside from nonunion) included 1 patient with persistent wrist pain that resolved with removal of hardware. Conclusions: The hybrid Russe technique for the treatment of scaphoid nonunions with humpback deformity demonstrates a 95% union rate. This technique is effective, reproducible, and may serve as an alternative to techniques that include structural grafts from distant sites.
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Affiliation(s)
| | | | - Robin N. Kamal
- Stanford University, Redwood City, CA, USA,Robin N. Kamal, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, MC: 6342, Redwood City, CA 94603, USA.
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14
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Morgan SDJ, Sivakumar BS, Graham DJ. Scaphoid plating for recalcitrant scaphoid fractures: a systematic review. J Hand Surg Eur Vol 2021; 46:616-620. [PMID: 33861659 DOI: 10.1177/17531934211005637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted a systematic review of scaphoid plating for recalcitrant scaphoid fractures using EMBASE, Pubmed, Cochrane and MEDLINE. Thirteen studies were included. Ninety-three per cent of cases reported were male with a mean age of 27 years. Bony union was reported in eleven studies and achieved in 72% to 100% of cases. Scaphoid plates showed no significant difference in union incidence compared with headless compression screws. Mean removal incidence of plates was 21%. Postoperative flexion-extension arc was 119°. Grip strength improved by 14% postoperatively over that before surgery. There was a general improvement in patient-reported outcome measures. Eighty-six per cent of reported participants returned to their previous work. In these clinical reports, plates frequently required removal more frequently than headless compression screws.
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Affiliation(s)
| | - Brahman S Sivakumar
- Australian Research Collaboration on the Hand (ARCH), Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia.,Hornsby Ku-Ring-Gai Hospital, Sydney, NSW, Australia
| | - David J Graham
- Gold Coast University Hospital, Southport, QLD, Australia.,Australian Research Collaboration on the Hand (ARCH), Australia
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15
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Van Nest DS, Reynolds M, Warnick E, Sherman M, Ilyas AM. Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes. J Wrist Surg 2021; 10:255-261. [PMID: 34109071 PMCID: PMC8169164 DOI: 10.1055/s-0040-1721405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions. Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution. Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores. Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.
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Affiliation(s)
- Duncan S. Van Nest
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Reynolds
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eugene Warnick
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Sherman
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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16
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Mittermayr R, Haffner N, Feichtinger X, Schaden W. The role of shockwaves in the enhancement of bone repair - from basic principles to clinical application. Injury 2021; 52 Suppl 2:S84-S90. [PMID: 33714550 DOI: 10.1016/j.injury.2021.02.081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
Extracorporeal shockwave therapy is a treatment modality, originally introduced into the clinic as lithotripsie, which has also been successfully used in the last two decades in the non-invasive treatment of delayed or non-healing fractures. Initially, the mechanism of action was attributed to microfracture-induced repair, but intensive basic research has now shown that the shockwave generates its effect in tissue via mechanotransduction. Numerous signal transduction pathways have already been demonstrated, which in their entirety trigger an endogenous regeneration process via cell proliferation, migration and differentiation. Clinically, these shockwave-conveyed biological signals support healing of acute, delayed and non-union fractures. The attainable outcome is comparable to surgery but avoiding an open approach with associated potential complications. These advantageous properties with a clearly positive cost-benefit ratio make shockwave therapy a first line treatment in delayed and non-union fractures.
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Affiliation(s)
- Rainer Mittermayr
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA Trauma Center Meidling, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria.
| | - Nicolas Haffner
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; Clinic Floridsdorf, Orthopedic and Traumatology Department, Vienna, Austria
| | | | - Wolfgang Schaden
- Ludwig Boltzmann Institute for experimental and clinical traumatology, Vienna, Austria; AUVA trauma research center, Vienna, Austria; Austrian Cluster for Tissue Engineering, Vienna, Austria; AUVA Medical Board, Vienna, Austria
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17
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Zhang H, Gu J, Liu H, Yuan C. Pedicled vascularized versus non-vascularized bone grafts in the treatment of scaphoid non-union: a meta-analysis of comparative studies. ANZ J Surg 2021; 91:E682-E689. [PMID: 33890706 DOI: 10.1111/ans.16894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Whether pedicled vascularized bone grafts (PVBGs) are beneficial over non-vascularized bone grafts (NVBGs) still remains controversial. The aim of this study was to compare the clinical results of PVBGs and NVBGs for the treatment of scaphoid non-union. METHODS We conducted a meta-analysis of the published studies comparing outcomes of these two different surgical techniques for scaphoid non-union. Outcomes of union rate, time to union, functional results and re-operation rate were analysed. RESULTS Seven studies including four randomized controlled studies and three retrospective comparative studies with 413 participants were identified fitting inclusion criteria. Meta-analysis showed that (i) union rate in PVBG groups was 1.13 times of NVBG groups (P = 0.002); (ii) the PVBG groups reached bone union significantly earlier by 1.73 weeks (P < 0.01); (iii) there was no significant difference in functional results, including active range of motion, grip strength, Mayo Wrist Score and excellent and good rate (P > 0.05); and (iv) re-operation rate was similar between the two groups (P = 0.65). CONCLUSIONS Although the PVBG technique attains higher union rate and earlier union, this radiological advantage does not bring any functional benefits. In addition, PVBGs are of greater technical difficulty and need more operation requirements. Hence, clinicians should be cautious in electing PVBGs for treating scaphoid non-union.
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Affiliation(s)
- Hanyu Zhang
- Department of Emergency Medicine, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jiaxiang Gu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongjun Liu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chaoqun Yuan
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.,Shanghai Tenth People's Hospital, Clinical Medical College of Nanjing Medical University, Shanghai, China
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18
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Knobloch K. [Extracorporeal magnetotransduction therapy (EMTT) and high-energetic focused extracorporeal shockwave therapy (ESWT) as bone stimulation therapy for metacarpal non-union - a case report]. HANDCHIR MIKROCHIR P 2021; 53:82-86. [PMID: 33588496 DOI: 10.1055/a-1344-8126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This case report describes the combination of a high-energetic focused extracorporeal shockwave therapy (ESWT) with an extracorporeal magnetotransduction therapy (EMTT) in the treatment of a non-union of the metacarpal V improving bone healing within six weeks.
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19
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Kaiser P, Brueckner G, Kastenberger T, Schmidle G, Stock K, Arora R. Mid-term follow-up of surgically treated and healed scaphoid fractures. HAND SURGERY & REHABILITATION 2021; 40:288-292. [PMID: 33549698 DOI: 10.1016/j.hansur.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the mid-term results of surgically treated scaphoid fractures since we were concerned that good results might deteriorate over time due to osteoarthritis or functional impairment. Thirty-three out of 121 surgically treated patients (isolated scaphoid fractures n = 23; scaphoid fractures with concomitant injuries n = 10) were evaluated retrospectively (47-138 months). Five patients (4%) had a non-union after internal fixation and were excluded because of additional treatment. The remaining 83 patients were not available for a follow-up examination. Patients with an isolated scaphoid fracture had a mean extension-flexion of 68°-0°-64°, a radial-ulnar deviation of 27°-0°-41° and a grip strength of 39 kg (corresponding to 87-98% of the uninjured contralateral wrist), while patients with concomitant injuries had a mean extension-flexion of 60°-0°-44°, radial-ulnar deviation of 22°-0°-38° and a grip strength of 42 kg (corresponding to 73-98% of the uninjured contralateral wrist). The Michigan Hand Questionnaire score was 85 and 75 and the Patient-Rated Wrist Evaluation score was 8 and 21, respectively. Fifteen patients had radiological signs of radiocarpal osteoarthritis with a significantly higher occurrence in those who had concomitant injuries compared to those with isolated scaphoid fractures (p < 0.01). There was no significant group difference in scaphotrapeziotrapezoid (STT) osteoarthritis (p = 0.968). One STT osteoarthritis case occurred after plate fixation, one after antegrade screw fixation and 10 after retrograde screw fixation. Surgical treatment of an acute isolated scaphoid fracture has excellent clinical, functional, and radiologic mid-term results, while scaphoid fractures with concomitant wrist injuries have slightly inferior results.
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Affiliation(s)
- P Kaiser
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Brueckner
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - T Kastenberger
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Schmidle
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - K Stock
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - R Arora
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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20
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Ek ET, Johnson PR, Bohan CM, Padmasekara G. Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss. J Wrist Surg 2021; 10:9-16. [PMID: 33552688 PMCID: PMC7850798 DOI: 10.1055/s-0040-1714252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15-38 years). The average time from initial injury was 16 months (range, 3-144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4-9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
| | - Paul R. Johnson
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Carmel M. Bohan
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Gayan Padmasekara
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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21
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Belloti JC, Vasconcelos KBL, Raduan Neto J, Okamura A, Fernandes M, de Moraes VY. Fixação percutânea sem enxerto ósseo para pseudartrose do escafóide. Rev Bras Ortop 2020; 55:759-763. [PMID: 33364656 PMCID: PMC7748942 DOI: 10.1055/s-0040-1712492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Abstract
Objective
To describe the clinical and radiographic outcomes of patients submitted to percutaneous fixation without bone graft for scaphoid nonunion, with a minimum follow-up of six months.
Methods
A case series study of a convenience sample of hand surgeons with prospective evaluation. Patients with scaphoid (waist or proximal pole) nonunion and the following features were included: more than six months of history; X-rays showing sclerosis of the edges of the nonunion, with resorption of the nonunion focus measuring less than 4 mm (Slade & Gleissler I, II, III and IV) and no angular deformity; and no proximal pole necrosis on magnetic resonance imaging (MRI).
Results
After six months of follow-up, all nonunion were consolidated, with no major complications. The functional outcomes revealed good scores on the disabilities of the arm, shoulder and hand (DASH; n = 12; mean: 6.9; standard deviation [SD]: 2.1) and patient-rated wrist evaluation (PRWE; n = 12; mean: 7.97, SD: 1.5) questionnaires. The results of the visual analog scale (VAS) showed little residual pain (n = 12; mean: 0.71; SD: 0.2). Slight decreases in flexion (69 versus 59.1;
p
= 0.007), extension (62.4 versus 48.7;
p
= 0.001) and radial deviation (29.6 versus 24.6;
p
= 0.014) were detected in comparison to the contralateral side.
Conclusions
All cases in the series presented consolidation and good functional scores at the six-month evaluation. This is a promising option (with lower technical demand and morbidity) for the treatment of scaphoid nonunion. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.
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Affiliation(s)
- João Carlos Belloti
- Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | | | - Jorge Raduan Neto
- Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Aldo Okamura
- Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Marcela Fernandes
- Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
| | - Vinícius Ynoe de Moraes
- Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brasil
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22
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Schormans PMJ, Kooijman MA, Ten Bosch JA, Poeze M, Hannemann PFW. Mid-term outcome of volar plate fixation for scaphoid nonunion. Bone Joint J 2020; 102-B:1697-1702. [PMID: 33249894 DOI: 10.1302/0301-620x.102b12.bjj-2019-1160.r3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. METHODS Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. RESULTS A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). CONCLUSION Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697-1702.
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Affiliation(s)
- Philip Marcel Jozef Schormans
- Department of Surgery, Amphia Hospital, Breda, The Netherlands.,Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maria A Kooijman
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan A Ten Bosch
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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23
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Does radial shock wave therapy works in pseudarthrosis? Prospective analysis of forty four patients. INTERNATIONAL ORTHOPAEDICS 2020; 45:43-49. [PMID: 33006647 DOI: 10.1007/s00264-020-04778-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In this study, we analyze a new treatment option for pseudarthrosis using radial shock waves. The traditional treatment to pseudarthrosis is surgical. As an option to specific cases, focal shock waves seem to present good results with bone union without a subsequent surgical procedure. As radial shock waves reach less energy and less depth penetration than focal shock waves, they usually are not indicated for the treatment of pseudarthrosis of any bone segment. There are publications that show evidences of the action of radial shock waves stimulating bone consolidation in vitro, in animals and in humans. We will present a new option for failure of consolidation in superficial bones submitted to radial shock wave therapy. OBJECTIVE To analyze the effectiveness of radial shock waves in the treatment of superficial bone pseudarthrosis. PATIENTS AND METHODS Between 2016 and 2019, we conducted a prospective study with 44 consecutive patients with pseudarthrosis. All patients had prior indication for treatment with surgery and were treated with radial shock waves as a nonsurgical treatment option. Patients were evaluated clinically and radiographically pre-treatment and 6 months after. Clinically, patients complained of pain and dysfunction, according to the segment affected, and radiographically, evidences of pseudarthrosis in at least two X-ray views. As the outcomes: satisfactory when there was bone union, no pain, and return function; unsatisfactory when there was no bone union and maintain pain and dysfunction. All patients were treated with the same equipment and by the same physician. The treatment consisted in 3 sessions with weekly interval; in each session, 3000 radial shock waves were applied with 4 bar of energy. RESULTS After 6 months, clinical analysis and X-ray evidence on 77.2% of the patients presented bone union and clinical improvement classified as satisfactory result. There were no complications. CONCLUSION Treatment of pseudarthrosis in superficial bones with radial shock waves is effective and safe.
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Mühldorfer-Fodor M, Wagner M, Kottmann T, van Schoonhoven J, Prommersberger KJ. [Comparison of scaphoid reconstruction with a non-vascularised bone graft, with and without shock waves; preliminary results]. HANDCHIR MIKROCHIR P 2020; 52:404-412. [PMID: 32992391 DOI: 10.1055/a-1250-8078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Focused, high energy shock wave therapy (ESWT) stimulates bone healing by neo-angiogenesis and activating osteocytes. This study investigates if applying an ESWT intraoperatively improves and accelerates the healing of a scaphoid nonunion after reconstruction using a non-vascularized bone graft. PATIENTS AND METHODS In this prospective, ongoing study, patients with a scaphoid reconstruction using a non-vascularized bone graft and stabilization for non-union, are randomized for having additionally an intraoperative ESWT (intervention group) or not (control group). In 6 weeks-intervals, patients have a clinical and radiological follow-up, including a CT scan at 12, 18, and if needed 24 weeks postoperatively. The intervention group and the control group are compared with regard to the proportion of the bridged contact area between scaphoid and the bone graft at 12, 18, and 24 weeks postoperatively and the rate of the healed scaphoids at the final follow-up. At time of this data analysis, 35 patients of the intervention group and 33 patients of the control group had passed all of their scheduled follow-ups. RESULTS Twenty-four weeks postoperatively, the scaphoids of 27 patients (77 %) in the intervention group and those of 20 patients (61 %) in the control group were healed. At 12, 18, and 24 weeks, the contact area between scaphoid and the bone graft proximally was bridged by 80 %, 84 %, and 86 % respectively in the intervention group, and 74 %, 81 %, and 84 % in the control group. Distal to the bone graft, the gap was bridged by 91 %, 94 %, and 95 % for the intervention group and 77 %, 90 %, and 94 % for the control group. At 12 weeks postoperatively, the proportional healing distal to the bone graft was significantly higher after ESWT. CONCLUSION A single, intraoperative ESWT improves the healing rate of scaphoid reconstruction with a non-vascularized bone graft and accelerates the gap bridging during the first 12 weeks after surgery.
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Affiliation(s)
| | - Matthias Wagner
- Klinik für Diagnostische Radiologie, Rhön Klinikum Campus Bad Neustadt
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Everding J, Stolberg-Stolberg J, Pützler J, Roßlenbroich S, Ochman S, Raschke M. Extracorporal shock wave therapy for the treatment of arthrodesis non-unions. Arch Orthop Trauma Surg 2020; 140:1191-1200. [PMID: 32036419 DOI: 10.1007/s00402-020-03361-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Non-union is a regular complication of arthrodeses. Standard treatment includes revision surgery with frequent need for re-revision due to persistent non-union. Particularly patients with concomitant diseases are at risk of secondary complications. There is a need for evaluation of alternative treatment options. The aim of this study is to provide first evidence on union-rate and pain course after focussed extracorporeal shock-wave therapy of arthrodesis non-unions. PATIENTS AND METHODS In a retrospective single-centre study, 25 patients with non-union following arthrodesis received one session of focussed extracorporeal shock-wave therapy (energy flux density 0.36 mJ/mm2, 3000 impulses, 23 kV, 4 Hz). Radiographic and clinical results were recorded 6, 12 and 24 weeks after treatment. RESULTS 24 patients were followed-up. After 24 weeks arthrodeses of the hand healed in 80%, of the upper ankle in 50%, of subtalar joint in 27.2% and of the midfoot in 0% of the cases. Pain decreased from 4.8 (± 2.8) points on the visual analogue scale to 3.4 (± 2.3), 2.9 (± 2.5) and 2.4 (± 2.8) points after 6, 12 and 24 weeks, respectively (p < 0.0001). CONCLUSION Our data indicate that the effect of focussed, high-energy shock wave therapy depends on body region and is effective for the treatment of non-unions of the hand as well as for pain relief. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jens Everding
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
| | - Josef Stolberg-Stolberg
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Jan Pützler
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Steffen Roßlenbroich
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Sabine Ochman
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
| | - Michael Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany
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Ansari SA, Kennedy JA, Younis F. Postoperative Outcomes of Volar Plate Fixation in Cases of Scaphoid Deformity or Nonunion: A Case Series. J Wrist Surg 2020; 9:304-311. [PMID: 32760609 PMCID: PMC7395847 DOI: 10.1055/s-0040-1710383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Background Fractures through the waist of scaphoid are a common injury, resulting in deformity or nonunion. Recently, a locking plate has been shown to fix deformity or nonunion of scaphoid, with limited observation of functional postoperative outcomes. Objectives We present a case series of 16 patients, with the disabilities of the arm, shoulder, and hand (DASH) score evaluation in primary fixation of scaphoid fractures with humpback deformity ( n = 11) and revision open reduction internal fixation (ORIF) for nonunion ( n = 5), using the Medartis TriLock 1.5 scaphoid plate and bone grafting. Patients and Methods DASH scores were obtained preoperatively and postoperatively at 3, 6, and 12 (if required) months. Patient demographics, smoking status, employment type, and grip strengths were recorded. Results Thirteen patients attended follow-up. Union was clinically and radiologically assessed with 13 achieving union. The mean preoperative DASH score was 34.0 ( n = 16) and at treatment completion (discharge or DNA) was 11.5 ( n = 13), with mean reduction of 18.5 ( p = 0.03). At treatment completion, mean reduction in DASH score of revision ORIF was 13.7 ( p = 0.27; n = 4), compared with 20.7 ( p < 0.01; n = 9) in primary fixation with plate. Conclusions Deformity correction, reduction in DASH score, and rate of union make the plate system useful in the management of scaphoid fractures with humpback deformity and revision for nonunion. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Saif A. Ansari
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - James A. Kennedy
- Department of Trauma and Orthopaedics, Health Education North West ST6 Trauma and Orthopaedics, Health Education North West, Lancashire, United Kingdom
| | - Fizan Younis
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
- Department of Hand Surgery, University of Central Lancashire, East Lancashire Hospitals National Health Service Trust, Lancashire, United Kingdom
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The Use of Nitinol Compression Staple Fixation and Bone Graft for Scaphoid Waist Fractures and Nonunion: A Surgical Technique. Tech Hand Up Extrem Surg 2020; 25:35-40. [PMID: 32544108 DOI: 10.1097/bth.0000000000000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the management of scaphoid fractures, nonunion is an important complication that can lead to carpal instability and early-onset arthritis. Various techniques have been described to treat scaphoid nonunions, yet a clear consensus on the superiority of one method is not yet established. The use of compression staple fixation has been described in the literature and may be a viable alternative to other fixation techniques. Volar Nitinol staple fixation avoids damage to the trapezium during retrograde fixation with a screw. It also avoids damage to the proximal dorsal cartilage, which occurs during anterograde screw fixation. Because of its shape and position on the volar aspect of the scaphoid, staple fixation provides compression, prevents graft extrusion, and avoids taking up space in the medullary canal of the scaphoid. Moreover, it may be technically easier than screw fixation. Despite these advantages, this technique has not been widely adopted. We describe the technique for utilizing Nitinol compression staples and bone grafting in the treatment of scaphoid nonunion.
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Eng K, Gill S, Hoy S, Shridar V, Van Zyl N, Page R. Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study. J Wrist Surg 2020; 9:225-229. [PMID: 32509427 PMCID: PMC7263855 DOI: 10.1055/s-0040-1702199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13-46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0-42) and mean PRWE was 11 (range 0-54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.
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Affiliation(s)
- Kevin Eng
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Stephen Gill
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Simon Hoy
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Vivek Shridar
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Natasha Van Zyl
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Richard Page
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
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Keller M, Kastenberger T, Anoar AF, Kaiser P, Schmidle G, Gabl M, Arora R. Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union. Arch Orthop Trauma Surg 2020; 140:835-842. [PMID: 32124031 PMCID: PMC7244456 DOI: 10.1007/s00402-020-03386-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction. MATERIALS AND METHODS Thirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically. RESULTS The overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22-5), DASH (59-19) and PRWE (62-30) score decreased significantly. The scapholunate (71°-65°) and radiolunate (28°-18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%). CONCLUSIONS The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.
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Affiliation(s)
- Marco Keller
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria ,grid.440128.b0000 0004 0457 2129Department of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Tobias Kastenberger
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Anizar Faizi Anoar
- grid.412516.50000 0004 0621 7139Department of Orthopaedics and Traumatology, Kuala Lumpur Hospital, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Peter Kaiser
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Markus Gabl
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- grid.5361.10000 0000 8853 2677Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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De Vitis R, Passiatore M, Perna A, Tulli A, Pagliei A, Taccardo G. Modified Matti-Russe technique using a "butterfly bone graft" for treatment of scaphoid non-union. J Orthop 2019; 19:63-66. [PMID: 32021039 DOI: 10.1016/j.jor.2019.11.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/24/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Autologous bone grafts are used to treat scaphoid non-union with shortening and humpback deformity. The superiority of internally fixed bone graft to embedded bone graft has not been clearly proven. Methods Retrospectively analyzed 42 cases of scaphoid waist non-union treated using the "butterfly bone graft" (modified Matti-Russe technique). Results Complete healing was reached by all patients, with an average time of 4.4 (SD ± 0.7) months. Mayo Wrist Score improved from and QuickDASH score significantly improved in all patients after treatment. Conclusions Butterfly bone graft is effective and reliable in treating scaphoid non-union with shortening and humpback deformity.
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Affiliation(s)
- Rocco De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
| | - Marco Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
| | - Antonio Tulli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
| | - Antonio Pagliei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
| | - Giuseppe Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Orthopedics Department of "Università Cattolica Del Sacro Cuore", Roma, Italy
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Quadlbauer S, Pezzei C, Jurkowitsch J, Krimmer H, Sauerbier M, Hausner T, Leixnering M. Palmare winkelstabile Verplattung von Pseudarthrosen und Trümmerfrakturen des Kahnbeins. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:433-446. [DOI: 10.1007/s00064-019-00623-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
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Mehling IM, Arsalan-Werner A, Wingenbach V, Seegmüller J, Schlageter M, Sauerbier M. Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 2019; 139:1161-1169. [PMID: 31123820 DOI: 10.1007/s00402-019-03196-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies. MATERIALS AND METHODS Between March 2010 and December 2014, 20 patients (age range 16-59 years) were treated with scaphoid locking plate osteosynthesis. In 17 cases it was due to scaphoid nonunion or delayed union and in three cases to treat a complex multi-fragmentary fracture of the scaphoid. Most of the initial fractures were located either in the proximal third (n = 9) or the middle third (n = 8) of the scaphoid. RESULTS Mean follow-up was 14.6 ± 8.9 months (range 2-30 months). All three scaphoid fractures (100%) showed bony healing in the CT scan after 2.7 ± 0.6 months. 15 of 17 (88.2%) patients with scaphoid nonunion demonstrated bony healing in the latest CT scan at an average of 6.2 ± 8.1 months (range 2-11 months) after scaphoid reconstruction. Range of motion (extension/flexion) was 104° ± 18.4° (range 80°-150°) and about one third less than the unaffected side. The average grip strength averaged 38.2 kg on the operated side and 44.1 kg on the unaffected side after surgery. 13 plates (65%) had to be removed due to impaction of the plate or protrusion of the screws. CONCLUSIONS This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.
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Affiliation(s)
- Isabella M Mehling
- Division for Hand Surgery, St. Vincent Hospital Hanau, Am Frankfurter Tor 19, 63450, Hanau, Germany.
| | - A Arsalan-Werner
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - V Wingenbach
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - J Seegmüller
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Schlageter
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Sauerbier
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
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