Reconstruction of proximal pole scaphoid non-union with avascular necrosis using proximal hamate: A four-case series

2021 ◽  
Author(s):  
S. Saruhan ◽  
A. Savran ◽  
M. Yıldız ◽  
M. Şener
Keyword(s):  
Avascular Necrosis ◽  
Case Series ◽  
Proximal Pole ◽  
Non Union

scholarly journals Avascular necrosis with non-union of the scaphoid managed with a dorsal pedicled vascularised bone graft of the distal radius – a case report

2021 ◽  
Vol 8 (10) ◽  
pp. 3189
Author(s):  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand P. Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Bone Remodelling ◽  
Bone Grafts ◽  
Vascular Supply ◽  
Favourable Outcome ◽  
Proximal Pole ◽  
Non Union ◽  
Hand Surgeon ◽  
Vascularised Bone Graft

Avascular necrosis (AVN) of the scaphoid is common following proximal pole fractures due to an arduous retrograde arterial vascular supply and it is a challenge to the hand surgeon. The treatment for scaphoid non-union with avascular necrosis is vascularized or non-vascularized bone grafts. Non vascularised bone grafts (NVBGs) can be categorized as autograft or allograft and cancellous or cortical bone grafts. Vascularised bone grafts promote biological healing and revascularizes ischaemic bone and they are free or pedicled grafts. Pedicled vascularised bone grafts maintain the vascular supply of the donor bone graft and this leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the non-vascularised graft with good clinical and radiological outcomes. In this paper, we have treated avascular necrosis of scaphoid with a pedicled vascularised bone graft based on the 1, 2 intercompartmental supraretinacular artery (1, 2-ICSRA) that resulted in a favourable outcome.

INTERCALATED BONE PEG IN THE TREATMENT OF NON-UNITED SCAPHOID FRACTURES

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 27-33
Author(s):  
Sameh El-Sallakh ◽  
Weam Mousa ◽  
Tarek Aly
Keyword(s):  
Time Lag ◽  
Case Series ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Non Union ◽  
Young Males ◽  
Scaphoid Fractures ◽  
Osteoarthritis Of The Wrist ◽  
Radiological Healing ◽  
Metal Work

Introduction: Untreated ununited scaphoid fractures will almost inevitably progress to radiographic and symptomatic osteoarthritis of the wrist. This may lead to subsequent morbidity and lifelong disability especially in young males in which the fracture scaphoid is more common. Patients and methods: Twenty-one patients presenting non-united fracture scaphoid were operated upon by using disto-proximal bone peg technique with average time between injury and operation as 11 months (6–18 months). All of them male with average age of 26 years (17–35 years). There were 17 patients with fracture waist (80.9%) and four patients with fracture proximal pole (19.1%). Results: Anatomy of the wrist was restored and radiological healing confirmed in 17/21, partial healing in 3/21 and non-union in 3/21 patients. Eighteen patients (85.7%) were graded as satisfactory, 5 patients (23.8%) were graded as excellent, ten patients (47.6%) were graded as good, and three patients (14.3%) were graded as fair. The remaining three patients (14.3%) were graded as unsatisfactory. Conclusion: We conclude that the disto-proximal bone peg technique of taking the graft from the ipsilateral ulna without using any metal work for fixing scaphoid non-union fracture is a reliable, easy, and inexpensive alternative method. However, we would not recommend it for the non-union of the scaphoid proximal pole fracture. Also we find the time lag before operation is one of the most important factors to achieve union in non-united fractures of the scaphoid. Level of evidence: Therapeutic case series, level 1V.

scholarly journals Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

2021 ◽  
Author(s):  
Cesare Faldini ◽  
Francesca Barile ◽  
Fabrizio Perna ◽  
Stefano Pasini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Mechanical Complication ◽  
Non Union ◽  
Implant Retention ◽  
Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

Hand ◽  
2020 ◽  
pp. 155894472097412
Author(s):  
Matteo Ferrero ◽  
Enrico Carità ◽  
Francesco Giacalone ◽  
Julien Teodori ◽  
Alberto Donadelli ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Early Mobilization ◽  
Functional Results ◽  
Good Alternative ◽  
Proximal Row Carpectomy ◽  
Proximal Pole ◽  
Subjective Outcomes ◽  
Clinical Worsening ◽  
Pyrocarbon Implant ◽  
Over Time

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

scholarly journals Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis

2006 ◽  
Vol 30 (2) ◽  
pp. 128-134 ◽  
Author(s):  
R. Bilic ◽  
P. Simic ◽  
M. Jelic ◽  
R. Stern-Padovan ◽  
D. Dodig ◽  
...  
Keyword(s):  
Proximal Pole ◽  
Non Union ◽  
Osteogenic Protein

scholarly journals Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Avascular Necrosis ◽  
Proximal Humerus ◽  
Constant Score ◽  
Surgical Techniques ◽  
Case Series ◽  
Cochrane Library ◽  
Operation Rate ◽  
Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score &gt;80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

scholarly journals Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article)

2020 ◽  
Author(s):  
C. Herrera-Vizcaino ◽  
L. Seifert ◽  
M. Berdan ◽  
S. Ghanaati ◽  
M. Klos ◽  
...  
Keyword(s):  
Complication Rate ◽  
Orthognathic Surgery ◽  
Mouth Opening ◽  
Case Series ◽  
Operation Time ◽  
University Hospital ◽  
Material Failure ◽  
Retrospective Case ◽  
Non Union ◽  
Facial Plastic

Abstract Background The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. Patient and methods The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. Results A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009–211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). Conclusion The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. Clinical relevance The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.

scholarly journals TRADITIONAL BONESETTERS

2016 ◽  
Vol 23 (06) ◽  
pp. 699-704
Author(s):  
Waqar Alam ◽  
Faaiz Ali Shah ◽  
Ashfaq Ahmed ◽  
Saeed Ahmad ◽  
Abdullah Shah
Keyword(s):  
Compartment Syndrome ◽  
Study Design ◽  
Low Cost ◽  
Cultural Beliefs ◽  
Case Series ◽  
Non Union ◽  
Appropriate Treatment ◽  
Accident And Emergency ◽  
Set Up ◽  
Study District

Objectives: To analyze the reasons for treatment by Traditional Bone Setters(TBS) and the frequency of complications in patients treated by traditional bone setters in our setup. Study Design: Descriptive case series. Place and Duration of Study: District HeadquarterHospital (DHQ) Temargarah & Lady Reading Hospital Peshawar and, Ghurki Trust TeachingHospital, Lahore from Dec 2014 to Nov 2015. Material and Methods: Patients of either genderor all ages received in outpatient department or accident and emergency of DHQ Temargarah,Lady Reading Hospital Peshawar and Ghurki Trust Teaching Hospital, Lahore with history oftrauma followed by treatment by local bonesetters were included in our study. After properhistory, examinations and investigations, appropriate treatment were given and complicationswere noted. Results: We received a total of 267 patients who were treated by Traditional bonesetters.186 were males and 81 were females. Age ranges from 1.5 years to 87 years. In majorityAdvice or pressure from family/friends taking the lead. 77(28.84%) of patients suffer because offamily or friends. 66(24.72%) of patients affected because of socio cultural beliefs, 46(17.23%)because of low cost, 35(13.11%) because of ignorance, 24(8.98%) because of fear of operation,19(7.12%) because of fear of amputation took their treatment from bone setters. The mostfrequent complication we received was malunion were found in 67(25.10%) and non-union in55(20.60%), Conclusion: Pressure from friends and family was the main reason for consultingTraditional Bone Setters for treatment in our set up and complications caused by their treatmentwere frequent and ranged from immediate compartment syndrome and gangrene of the limb tolate onset mal union, non-union and avascular non-union.

scholarly journals Complications after Displaced Talar Neck Fracture: Results from a Case Series and a Critical Review of Literature

2018 ◽  
Vol 12 (1) ◽  
pp. 567-575
Author(s):  
D. Leonetti ◽  
B. Di Matteo ◽  
P. Barca ◽  
S. Cialdella ◽  
F. Traina ◽  
...  
Keyword(s):  
Functional Performance ◽  
Case Series ◽  
Clinical Results ◽  
Fracture Dislocation ◽  
Review Of Literature ◽  
Non Union ◽  
Fracture Dislocations ◽  
Neck Fracture ◽  
Talar Fractures

Introduction: Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications. The aims of the present study are: 1) to review the available evidence concerning the outcome and complications of talar neck fractures; 2) to describe the clinical results and the rate of post-op complications in a series of patients treated surgically after talar fracture-dislocations. Materials and methods: The review of the literature was performed on the Pubmed, Embase and Web of Science databases and aimed at identifying clinical trials with at least 10 patients and dealing with surgical management of talar fracture-dislocation (Hawkins grade II to IV). All the papers were analyzed to extract data concerning common complications such as non-union, mal-union, infection, osteonecrosis and osteoarthtritis. The clinical arm of this paper included 26 patients (19 men and 7 women), who underwent fixation of displaced talar fracture by cannulated screws and were retrospectively evaluated, both clinically and radiographically, at a mean 51.2 ± 23.4 months of follow-up. Results: The evaluation through the AOFAS score revelead a loss of functional performance with respect to the pre-injury status. Four patients were re-operated within final follow up, whereas the remaining 22 presented excellent results in 2 cases, good results in 4 cases, fair results in 11 cases and poor results in 5 cases. Osteoarthritis and osteonecrosis incidence were 51.9% and 25.9% respectively. Sixteen studies were included in the review and it was confirmed that the most frequent complication was post-traumatic OA, followed by osteonecrosis and mal-union. A variable range in percentage of complications described should be ascribed to the low quality of trials currently available. Conclusion: Displaced talar fracture are challenging to treat and the outcomes at middle-term are often modest. Looking at complications, the present case series and the review of literature revealed that the most common one is peritalar OA. Osteonecrosis, traditionally regarded as the most fearsome adverse event, is relevant but less frequent than OA.

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