The treatment of scaphoid nonunion. A review of a novel technique using precision bone grafting compared with Herbert screw fixation and bone graft

Modulation of Osteogenesis in MC3T3-E1 Cells by Different Frequency Electrical Stimulation

Electrical stimulation (ES) is therapeutic to many bone diseases, from promoting fracture regeneration to orthopedic intervention. The application of ES offers substantial therapeutic potential, while optimal ES parameters and the underlying mechanisms responsible for the positive clinical impact are poorly understood. In this study, we assembled an ES cell culture and monitoring device. Mc-3T3-E1 cells were subjected to different frequency to investigate the effect of osteogenesis. Cell proliferation, DNA synthesis, the mRNA levels of osteosis-related genes, the activity of alkaline phosphatase (ALP), and intracellular concentration of Ca²⁺ were thoroughly evaluated. We found that 100 Hz could up-regulate the mRNA levels of collagen I, collagen II and Runx2. On the contrary, ES could down-regulate the mRNA levels of osteopontin (OPN). ALP activity assay and Fast Blue RR salt stain showed that 100 Hz could accelerate cells differentiation. Compared to the control group, 100 Hz could promote cell proliferation. Furthermore, 1 Hz to 10 Hz could improve calcium deposition in the intracellular matrix. Overall, these results indicate that 100Hz ES exhibits superior potentialities in osteogenesis, which should be beneficial for the clinical applications of ES for the treatment of bone diseases.

A new variant of scaphoid reconstruction: Treatment of scaphoid non-union with avascular bone interponate and high compression screw (Synthes(®))

Scaphoid fractures as frequently overseen injuries often result in scaphoid non-unions, that need to be treated to prevent carpal collapse and secondary cartilage damage. Vital bone tissue and compression of fracture and bone graft ends seem to be crucial in for ossification and final bone healing. In the present study we compare our results using a high compression screw (HCS Synthes^®) to results in the literature using different kinds of internal fixation including compression screws of various types. We present 22 patients with scaphoid non-unions treated with a bone graft and a HCS Synthes^®. We evaluated our post-operative results. The Manchester-Modified Disability of the Shoulder, Arm and Hand–Score (M-Dash) imposed with an average of 29.8 points (MD=29 / SD=9.46 / MIN=18 / MAX=48). None of the re-evaluated patients sorrowed for pain in rest. Five patients stated pain (ranging from 4 to 8 on numeric analogue scale) after heavy burden (e.g. boxing, weight lifting).In exploring the range of motion of the operated hand we deliver the following results: dorsal extension: average 72.73° (MD=80° / SD=17.23° / MIN=30° / MAX=85°), flexion: average 73.64° (MD=80° / SD=8.97° / MIN=60° / MAX=80°), ulnar deviation: average 39.09°, (MD=40° / SD=2.02° / MIN=35° / MAX=40°), radial deviation: average 29.09°, (MD=30° / SD=3.01° / MIN=20° / MAX=30°). Additionally a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 100%, moderate pain in n=1 (8.33%), opposition digitus manus I–V complete in 100%, moderate pain n=2 (16.67%). Three patients with persisting fracture gap had a scaphoid bone fractured in the proximal third; one patient even with a very small proximal fragment. One persisting non-union was localized in the middle third (period between injury and operation = 5 years). In conclusion, our patients showed better healing rates compared to results presented in the literature. Non-unions localized in the proximal third of the scaphoid did not seem to benefit using this technique.

Scaphoid nonunion fracture and results of the modified Matti-Russe technique

Background:

The best treatment for scaphoid nonunion fractures is still controversial. The main aim of this study was to determine the results of the modified Matti-Russe method of surgery on scaphoid nonunion.

Materials and Methods:

In this prospective interventional study, 30 patients with nonunion scaphoid fracture recruited from clinics of the Isfahan University of Medical Sciences between October 2007 and March 2011 underwent the modified Matti-Russe method of surgery. Union rate was evaluated four and six months after the procedure. Mayo wrist score (MWS) was calculated for the subjects six months after surgery.

Results:

Mean age of the subjects was 25.9 ± 7.8 years, ranging from 16 to 35 years. Twenty-seven (90%) were men, and three (10%) were women. Four and six months after surgery, 10 (33%) and 26 (86.7%) subjects had a united fracture. Mean MWS was 75.0 ± 8.8 in all the subjects, ranging from 54 to 90 six months after surgery. Three subjects (10%) were grouped as excellent, 9 (30%) good, 16 (53.3%) satisfactory, and 3 (6.7%) poor.

Conclusion:

A fracture or nonunion of the scaphoid bone can be a complex and troubling injury, but the modified Matti-Russe method showed satisfactory results six months after surgery.