The Effect of Malunited Scaphoid Fractures on Joint Congruency

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

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DORSAL OPEN REPAIR OF PROXIMAL POLE SCAPHOID FRACTURES

Hand Clinics ◽

10.1016/s0749-0712(21)01444-x ◽

2001 ◽

Vol 17 (4) ◽

pp. 601-610

Author(s):

Keith B. Raskin ◽

Debra Parisi ◽

Janet Baker ◽

Michael E. Rettig

Keyword(s):

Open Repair ◽

Proximal Pole ◽

Scaphoid Fractures

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Long-term outcomes after corrective cartilaginous joint resection based on arthrographic findings of duplicated thumbs

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193421994780 ◽

2021 ◽

Vol 46 (4) ◽

pp. 367-372

Author(s):

Kousuke Iba ◽

Akira Saito ◽

Megumi Hanaka ◽

Toshihiko Yamashita

Keyword(s):

Growth Period ◽

Joint Space ◽

Type Ii ◽

Scoring Method ◽

Joint Congruency ◽

Thumb Duplication ◽

Age At Surgery ◽

Joint Connection

We report greater than 10-year outcomes in duplicated thumbs following corrective cartilaginous resection during the growth period. We have undertaken corrective resection of cartilaginous joint connections based on intraoperative arthrographic findings to reconstruct favourable alignment in six Wassel Type II and IV thumb duplication in six patients. The age at surgery was 13 months (range 10–15), and the average post-surgical follow-up was 134 months (range 120–160). We observed five excellent and one good outcome using the Japanese Society for Surgery of the Hand scoring method. Favourable joint congruency and alignment were preserved, and no growth plate arrest or joint space narrowing was present more than 10 years after surgery. We conclude that corrective resection of the cartilaginous joint based on intraoperative arthrographic findings has long-term reliability for duplicated thumbs, especially those of Wassel Type II and IV, which have a cartilaginous joint connection. Levels of evidence: IV

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Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Journal of Wrist Surgery ◽

10.1055/s-0040-1701512 ◽

2020 ◽

Vol 09 (03) ◽

pp. 203-208

Author(s):

Kristin E. Shoji ◽

F. Joseph Simeone ◽

Sezai Ozkan ◽

Chaitanya S. Mudgal

Keyword(s):

Bone Graft ◽

Common Mechanism ◽

Study Cohort ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Local Bone ◽

Case Series Study ◽

Increased Risk ◽

Surgical Fixation ◽

The Mean

Abstract Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

Journal of Wrist Surgery ◽

10.1055/s-0039-3402769 ◽

2020 ◽

Vol 09 (02) ◽

pp. 141-149

Author(s):

Pooja Prabhakar ◽

Lauren Wessel ◽

Joseph Nguyen ◽

Jeffrey Stepan ◽

Michelle Carlson ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Scaphoid Fracture ◽

Receiver Operating Curve ◽

Scaphoid Nonunion ◽

Retrospective Case ◽

Level Of Evidence ◽

Fracture Location ◽

Scaphoid Fractures ◽

Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

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