Treatment of Proximal Scaphoid Non-union by Resection of the Proximal Pole and Palmaris Longus Interposition Arthroplasty

2015 ◽  
Vol 47 (03) ◽  
pp. 171-174
Author(s):  
F. Smeraglia ◽  
G. Ciaramella ◽  
S. Cerbasi ◽  
G. Balato ◽  
M. Mariconda
Keyword(s):  
Proximal Pole ◽  
Interposition Arthroplasty ◽  
Non Union ◽  
Palmaris Longus

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 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.

Imaging the Position of a Screw within the Scaphoid

1993 ◽  
Vol 18 (6) ◽  
pp. 716-724 ◽  
Author(s):  
J. P. COMPSON ◽  
F. W. HEATLEY
Keyword(s):  
Proximal Pole ◽  
Radiological Study ◽  
Bone Screw ◽  
Non Union ◽  
Scaphoid Fractures ◽  
Distal Pole ◽  
Screw Position

In an audit of 68 scaphoid fractures with delayed and non-union that had been internally fixed using the Herbert bone screw, it was found that 39 had a significant fault in screw position. Poor intra-operatrve imaging was a major contributing factor. An anatomical and radiological study was therefore performed to evaluate which views were necessary in order to be confident about screw position. We recommend a minimum of four views. To display the proximal pole, an ulnar deviated postero-anterior (PA) view and true lateral; and to display the distal pole, a semi-pronated and semi-supinated view.

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.

Rupture of the Flexor Pollicis Longus Tendon Resulting from the Non-Union of a Scaphoid Fracture

1988 ◽  
Vol 13 (1) ◽  
pp. 80-82
Author(s):  
A. B. CROSS
Keyword(s):  
Similar Case ◽  
Scaphoid Fracture ◽  
Interphalangeal Joint ◽  
Flexor Pollicis Longus ◽  
Proximal Pole ◽  
Non Union ◽  
Longus Tendon ◽  
Good Movement ◽  
Flexor Pollicis Longus Tendon

A case is described in which a patient presented with a rupture of the flexor pollicis longus tendon resulting from an ununited scaphoid fracture. No similar case appears to have been reported in the literature. This was not an attrition rupture and the mechanism is explained. The proximal pole of the scaphoid was removed and the tendon repaired. The patient regained good movement at the interphalangeal joint of the thumb.

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.

Vascularized medial femoral condyle graft for management of scaphoid non-union

2014 ◽  
Vol 40 (8) ◽  
pp. 848-854 ◽  
Author(s):  
A. Elgammal ◽  
B. Lukas
Keyword(s):  
Bone Graft ◽  
Blood Supply ◽  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Proximal Pole ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Non Union ◽  
Structural Support

The purpose of this study was to assess the results of the management of difficult scaphoid non-unions using a vascularized medial femoral condyle graft. We operated on 30 patients with necrosis of the proximal pole or with severe humpback deformity or who presented with persistent non-union despite previous surgery. Twenty-four cases in our series showed full consolidation and six cases showed persistent non-union. The free vascularized medial femoral condyle bone graft can provide not only structural support, but also a consistent and good blood supply that results in excellent rates of union. Level of evidence: IV

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.

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