Scaphoid Nonunion with Avascular Necrosis of the Proximal Pole

1998 ◽  
Vol 23 (5) ◽  
pp. 686-690 ◽  
Author(s):  
M. I. BOYER ◽  
H. P. VON SCHROEDER ◽  
T. S. AXELROD
Keyword(s):  
Avascular Necrosis ◽  
Distal Radius ◽  
Bone Grafting ◽  
Difficult Problem ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Interposition Graft ◽  
Loss Of Motion ◽  
Grafting Procedure

Scaphoid nonunion with avascular necrosis of the proximal pole remains a difficult problem. We have endeavoured to heal the fracture, restore scaphoid height and revascularize the proximal pole of the scaphoid by means of a vascularized dorsal interposition graft from the distal radius. The procedure has resulted in union of six of ten fractures. Fractures that healed had not been treated by a previous bone grafting procedure. Dissatisfaction was due to loss of motion in patients who had healed fractures, and pain in those patients with persistent non-unions.

Dorsal capsular-based vascularized distal radius graft for proximal pole scaphoid nonunion with avascular necrosis

Injury ◽  
2021 ◽  
Author(s):  
Loukia K. Papatheodorou ◽  
Dimitrios V. Papadopoulos ◽  
Micaela M. Graber ◽  
Dean G. Sotereanos
Keyword(s):  
Avascular Necrosis ◽  
Distal Radius ◽  
Scaphoid Nonunion ◽  
Proximal Pole

TECHNIQUES FOR VASCULARISED BONE GRAFTING IN SCAPHOID NONUNION

Hand Surgery ◽  
1999 ◽  
Vol 04 (01) ◽  
pp. 21-31 ◽  
Author(s):  
D. J. Wheen ◽  
M. Robinson ◽  
S. Prachaporn ◽  
S. Visvanathan
Keyword(s):  
Internal Fixation ◽  
Bone Graft ◽  
Avascular Necrosis ◽  
Bone Grafting ◽  
Bone Grafts ◽  
Significant Problem ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Scaphoid Fractures

Nonunion of the scaphoid remains a significant problem in the management of scaphoid fractures. Recurrent persistent nonunion following attempts at internal fixation, and nonunions with sclerosis or avascular necrosis of the proximal pole of the scaphoid are particularly challenging. However, the aims of restoration of scaphoid anatomy and the achievement of union of the scaphoid remain the foundation pillars of scaphoid treatment. In recent years, several techniques for using vascularised bone grafts in the treatment of these difficult problems have been described. This article will review the currently described treatments, provide an overview of our unit experience with these techniques, and also describe a technique for in situ vascularisation of a conventional bone graft.

Fixation of proximal pole scaphoid nonunion with non-vascularized cancellous autograft

2017 ◽  
Vol 43 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Timothy J. Luchetti ◽  
Allison J. Rao ◽  
John J. Fernandez ◽  
Mark S. Cohen ◽  
Robert W. Wysocki
Keyword(s):  
Distal Radius ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Screw Fixation ◽  
Tomographic Imaging ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Iliac Crest Bone Grafting

We present 20 patients with established proximal pole scaphoid nonunions treated with curettage and cancellous autograft from the distal radius and screw fixation. Fractures with significant proximal pole fragmentation were excluded. Patients were treated at a mean of 26 weeks after injury (range 12–72). Union occurred in 18 of 20 patients (90%) based on computed tomographic imaging. The two nonunions that did not heal were treated with repeat curettage and debridement and iliac crest bone grafting without revision of fixation. Union was achieved in both at a mean of 11 weeks after the revision procedures. Our findings suggest that non-vascularized cancellous autograft and antegrade fixation is a useful option for the treatment of proximal pole scaphoid nonunions. Level of evidence: IV

scholarly journals The Outcome of Using a Jamshidi Biopsy Trocar Needle in a Novel Technique for Bone Grafting in Percutaneous Internal Fixation of Scaphoid Non-Union

2018 ◽  
Vol 6 (3) ◽  
pp. 506-510
Author(s):  
Syed Bokhari ◽  
Saifullah Hadi ◽  
Fahad Hossain ◽  
Bernd Ketzer
Keyword(s):  
Internal Fixation ◽  
Distal Radius ◽  
Bone Grafting ◽  
Proximal Pole ◽  
Union Rate ◽  
Non Union ◽  
Novel Technique ◽  
Grafting Technique ◽  
Percutaneous Internal Fixation ◽  
Time From Injury

INTRODUCTION: We report the outcome of using a novel technique of minimally invasive internal fixation and distal radius bone grafting using the Jamishidi Trephine needle and biopsy/graft capture device.METHODS: The technique utilises a 8 mm incision at the distal pole of the scaphoid. The non-union is excavated using the standard Acutrak drill. An 8 gauge Jamshidi trephine needle is used to harvest bone graft from the distal radius which is impacted into the scaphoid and fixed with an Acutrak screw. Fifteen patients were available for retrospective review, 14 male, age mean 29.5 (15-56). Average time from injury to surgery was 167 days (45-72). Fractures classified according to Herbert giving 7 D1 and 8 D2 fractures, 14 waist and 1 proximal pole fractures, all of which had no humpback deformity.RESULTS: Sixty-six percentages of the fractures went onto unite, 4/7 D1 and 6/8 D2 united (p > 0.05). Seventy-five percentages of fracture that had surgery in less than 3 months from time of injury went onto unite, whereas only 63% united in patients who had surgery later than 3 months (p > 0.05). DASH outcome for all patients improved from 86 down to 32 (p < 0.05). With those that united going down from 90 to 6. Those that did not unite went from 81 to 61.CONCLUSION: The Jamshidi bone grafting technique shows comparable results (union rate 66%) to other techniques published in the literature (27-100%) providing the surgeon with an alternative and less demanding procedure than open scaphoid non-union surgery.

Primary Vascularized Distal Radius Bone Graft for Nonunion of the Scaphoid

2000 ◽  
Vol 25 (3) ◽  
pp. 266-270 ◽  
Author(s):  
C. UERPAIROJKIT ◽  
S. LEECHAVENGVONGS ◽  
K. WITOONCHART
Keyword(s):  
Bone Graft ◽  
Avascular Necrosis ◽  
Distal Radius ◽  
Pinch Strength ◽  
Type I ◽  
Vascularized Bone Graft ◽  
Proximal Pole ◽  
The Mean ◽  
Mean Time ◽  
Vascularized Bone

A vascularized bone graft from the dorsoradial aspect of the distal radius was used with internal fixation to treat nonunion of the scaphoid in ten patients who had not received any previous surgical treatment. Five cases were classified as Lichtman type I and five as type II. The average age was 30 years (range, 18–40 years). Associated avascular necrosis was observed in five cases. Post-operatively pain was relieved and union was achieved in all cases. The mean time to union was 6.5 weeks. Range of motion, grip strength and pinch strength were also restored satisfactorily. These results suggest that this vascularized bone graft should be used as the primary procedure in Lichtman type I and II of scaphoid nonunions, regardless of the presence of avascular necrosis of the proximal pole.

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.

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