Failure of Surgery for Scaphoid Non-Union is Associated with Smoking

2006 ◽  
Vol 31 (3) ◽  
pp. 252-255 ◽  
Author(s):  
C. P. LITTLE ◽  
B. J. BURSTON ◽  
J. HOPKINSON-WOOLLEY ◽  
P. BURGE
Keyword(s):  
Bone Grafting ◽  
Smoking Prevalence ◽  
Screw Fixation ◽  
Delayed Union ◽  
Proximal Pole ◽  
Non Union ◽  
Scaphoid Fractures ◽  
The Uk ◽  
Vascularized Bone

Scaphoid fractures predominantly affect young men, in whom the UK smoking prevalence approaches 40%. We examined the association between smoking and failure of non-vascularized bone grafting and screw fixation for scaphoid non-union and delayed union in a retrospective cohort study. Adequate follow-up was obtained in 64 of 87 patients treated (74%). Union was defined as the presence of trabecular continuity on at least two films from a four-view radiographic series. Union was achieved in 47 of 64 cases. Seventeen were smokers. Thirteen of the 17 patients with non-union were smokers (relative risk 3.7; 95% CI: 1.3–10.1, p = 0.005). Proximal pole fractures, long injury-grafting interval and non-compliance were not more frequent in smokers than non-smokers. Smoking is strongly associated with failure of union after screw fixation and non-vascularized bone grafting of the scaphoid. Smokers should be advised to avoid smoking pre-operatively and during the healing period.

A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Syed Shumon ◽  
Moin Durrani ◽  
Karthikeyan P. Iyengar ◽  
William Y. C. Loh
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Carpal Bone ◽  
Non Union ◽  
Scaphoid Fractures ◽  
First Case ◽  
Vascularized Bone ◽  
Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

Experience with Scaphoid Grafting

1997 ◽  
Vol 22 (2) ◽  
pp. 153-160 ◽  
Author(s):  
N. J. BARTON
Keyword(s):  
Clinical Result ◽  
Bone Grafting ◽  
Bony Union ◽  
Radiological Outcome ◽  
Proximal Pole ◽  
Herbert Screw ◽  
Scaphoid Fractures ◽  
Radiological Results ◽  
Clinical And Radiological Results

Over a period of 24 years, the author has used five different methods of bone-grafting for ununited scaphoid fractures. The clinical and radiological results have been reviewed, with a minimum follow-up of 1 year. Radiologically the best results (78% definite union) were obtained with a “wedge” graft and Herbert screw, while the worst results followed the original Russe operation. The clinical result often did not coincide with the radiological outcome. All methods led to a decrease in pain in most cases, but little or no pain was achieved most often by the modified Russe graft. With proximal pole fractures, bony union was only achieved in 54% but the symptoms were always lessened.

Scaphoid Nonunion: Treatment with a Pedicled Vascularized Bone Graft Based on the 1,2 Intercompartmental Supraretinacular Branch of the Radial Artery

2002 ◽  
Vol 27 (5) ◽  
pp. 413-416 ◽  
Author(s):  
R. G. STRAW ◽  
T. R. C. DAVIS ◽  
J. J. DIAS
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Vascularized Bone Graft ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Union Rate ◽  
Fracture Nonunions ◽  
Vascularized Bone

Pedicled vascularized bone grafts (Zaidemberg’s technique) were used to treat 22 established scaphoid fracture nonunions, 16 of which were found to have avascular proximal poles at surgery. After a follow-up of 1–3 years, only six (27%) of the 22 fracture nonunions had united. Only two of the 16 nonunions with avascular proximal poles united, compared with four of the six nonunions with vascular proximal poles. We conclude that this technique of pedicled vascularized bone grafting may not improve the union rate for scaphoid fracture nonunions with avascular proximal pole fragments.

Vascularised Bone Grafting in the Management of Scaphoid Non-Union – A Review of 34 Cases

2008 ◽  
Vol 33 (5) ◽  
pp. 628-631 ◽  
Author(s):  
A. K. KAPOOR ◽  
N. W. THOMPSON ◽  
I. RAFIQ ◽  
M. J. HAYTON ◽  
J. STILLWELL ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Statistical Significance ◽  
Dominant Hand ◽  
Proximal Pole ◽  
Non Union ◽  
Risk Of Failure

We reviewed the outcomes of 34 patients who had undergone vascularised bone grafting for a chronic scaphoid non-union. Mean age was 27 years (range 16–46 years). The dominant hand was involved in 17 cases. Eleven patients were smokers. In 18 cases the fracture involved the proximal and in 16 cases the middle third of the scaphoid. In 26 patients the proximal scaphoid fragment was deemed avascular. Sixteen patients had previously undergone scaphoid fixation and non-vascularised bone grafting. At a follow-up of 1 to 3 years (mean 1.6 years), 15 of the 34 scaphoid non-unions had united. Injury to the dominant hand and duration of the non-union significantly increased the risk of failure. Persistent non-union was more common in proximal third fractures and in the presence of an avascular proximal pole but these findings did not reach statistical significance.

A Prospective Study of Acute Undisplaced and Minimally Displaced Scaphoid Fractures Managed by Aggressive Conservative Approach

2018 ◽  
Vol 23 (01) ◽  
pp. 18-25 ◽  
Author(s):  
Anil K. Bhat ◽  
Ashwath M. Acharya ◽  
S Manoh ◽  
Vinay Kamble
Keyword(s):  
Ct Scan ◽  
Screw Fixation ◽  
Delayed Union ◽  
Fracture Site ◽  
Percutaneous Fixation ◽  
Percutaneous Screw Fixation ◽  
Non Union ◽  
Scaphoid Fractures ◽  
One Year ◽  
A Prospective Study

Background: To identify acute un-displaced and minimally displaced scaphoid fractures which are unlikely to unite with non-operative treatment at six weeks with CT scan and stabilize them with percutaneous screw fixation with the aim of preventing non-union. Methods: A scaphoid series radiographs of wrist were obtained for patients with undisplaced or minimally displaced fractures and were immobilized in a thumb spica cast for six weeks. At six weeks, CT scan was done for patients showing doubtful signs of clinical and radiographic union. Patients with a gap less than 2 mm were continued on cast for an additional two to four weeks. Those with gap more than 2 mm underwent percutaneous screw fixation. In both cases the immobilisation was discontinued when the fracture was considered to be united and mobilization was initiated. Results: 21 out of 39 patients managed initially with cast for six weeks showed clinical and radiological evidence of union. 18 patients showed persistent tenderness of which eight showed a clear gap in radiographs and 10 patients had doubtful union. Eight of these 10 patients on CT scan showed fracture gap of more than 2 mm while two patients showed fracture gap of less than 2 mm. Hence, 16 patients underwent percutaneous fixation. Repeat radiographs showed progression to union at an average of 3.8 weeks from surgery. Remaining two eventually united on continuing the cast. All patients showed confirmed union at one year on follow up. Conclusions: An objective measurement of fracture gap by CT scan at six weeks is useful in predicting cases with tendency for delayed union. Early percutaneous fixation of fractures would not further jeopardize the blood supply of fracture site. This aggressive conservative management also avoids unnecessary surgery in all acute scaphoid fractures.

scholarly journals Outcome of vascularised muscle pedicle bone graft for scaphoid non-union

2018 ◽  
Vol 4 (2) ◽  
pp. 203
Author(s):  
Rajat Charan ◽  
Pankaj Kumar Verma
Keyword(s):  
Bone Graft ◽  
Screw Fixation ◽  
Proximal Pole ◽  
Hardware Failure ◽  
Non Union ◽  
Herbert Screw ◽  
Vascularised Bone Graft ◽  
Full Correction ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The objective of the study was to assess the <span lang="EN-IN">outcome of vascularised muscle pedicle bone graft for scaphoid non-union.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">14 men and 6 women aged 18-45 (mean 25) years with non-union of scaphoid involving proximal pole (n=4), waist (n=14), distal pole (n=2) were randomized to undergo vascularised muscle pedicle bone graft with Herbert screw fixation. The mean duration of non-union was 10 months (range 4-14 months)</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The mean follow up duration was 24 months. 17 of 20 achieved union. 12 of 20 achieved correction of both scapholunate and radiolunate angle. 5 of 20 did not achieve full correction of sacpholunate and radiolunate angle. 3 of 20 did not achieve union. 2 of these 3 were associated with proximal pole absorption. There was no hardware failure or any iatrogenic fracture during pedicle dissection. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The use of vascularised bone graft has proved to be an effective method for treating scaphoid non-union, especially non-union with an avascular proximal pole and those that have failed to heal after previous procedure.</span></p>

Consequences of Late Immobilization of Scaphoid Fractures

1988 ◽  
Vol 13 (1) ◽  
pp. 77-79
Author(s):  
O. LANGHOFF ◽  
J. L. ANDERSEN
Keyword(s):  
Delayed Union ◽  
Bony Union ◽  
Proximal Pole ◽  
Non Union ◽  
Scaphoid Fractures ◽  
The Relationship

In order to determine the relationship between delay before immobilization and the development of non-union or delayed union, 285 fractures of the scaphoid have been analysed from records and radiographs. 16 non-unions and 25 of 27 fractures with delayed union were found in proximal pole or waist fractures in adults, which were analyzed separately. No increment in the time to bony union or in the incidence of non-union was found following a delay of immobilization of less than four weeks, but when the delay exceeded four weeks, most fractures had healing complications.

Modified carpal box technique in the diagnosis of suspected scaphoid fractures

2003 ◽  
Vol 44 (3) ◽  
pp. 319-325 ◽  
Author(s):  
F. Toth ◽  
S. Mester ◽  
G. Cseh ◽  
A. Bener ◽  
J. Nyarady ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Diagnostic Algorithm ◽  
Referral Rate ◽  
Radiographic Evaluation ◽  
Diagnostic Modality ◽  
Non Union ◽  
Scaphoid Fractures ◽  
Sensitivity Specificity ◽  
Very High

Purpose: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. Material and Methods: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. Results: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. Conclusion: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

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