scholarly journals A Critical Appraisal of Vascularized Bone Grafting for Scaphoid Nonunion

2016 ◽  
Vol 06 (03) ◽  
pp. 251-257 ◽  
Author(s):  
Ram Alluri ◽  
Christine Yin ◽  
Matthew Iorio ◽  
Hyuma Leland ◽  
Wendy Mack ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Surgical Techniques ◽  
Scaphoid Nonunion ◽  
Patient Centered ◽  
Level Of Evidence ◽  
Revision Procedure ◽  
Vascularized Bone

Background Vascularized bone grafting (VBG) has the potential to yield reliable results in scaphoid nonunion; however, results across studies have been highly variable. This study critically evaluates surgical techniques, fracture location, and patient selection in relation to radiographic, clinical, and patient-centered outcomes after VBG for scaphoid nonunion. Methods We conducted a systematic review of the literature for the use of VBG in scaphoid nonunion. Physical examination, radiographic, and patient-centered outcomes were assessed. Four substratifications were performed: the location of scaphoid nonunion, pedicled versus free technique, Kirschner wire (K-wire) versus screw fixation, and VBG done as a primary versus revision procedure. Results A total of 41 publications were included in final analysis. VBG had an 84.7% union rate at 13 weeks after surgery. On an average, 89% of patients returned to preinjury activity levels by 18 weeks after surgery and 91% of patients reported satisfaction with the procedure. Proximal pole nonunions demonstrated similar union rates but lower functionality scores compared with nonunions across all regions of the scaphoid. Pedicled techniques demonstrated slightly improved range of motion compared with free technique. K-wire versus screw fixation demonstrated significantly higher union rates and faster union times. There were no differences in outcomes for VBG done as a primary versus revision procedure. Conclusion VBG serves as a viable option for the treatment of scaphoid nonunion, with consistent union rates in addition to significantly improved postoperative patient functionality. The fixation of these vascularized bone grafts with K-wires versus screw fixation may result in superior radiologic outcomes. Level of Evidence Therapeutic, Level III, systematic review.

Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis

2017 ◽  
Vol 43 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Jihyeung Kim ◽  
Jin Woo Park ◽  
Jeehyeok Chung ◽  
Kee Jeong Bae ◽  
Hyun Sik Gong ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Bone Grafting ◽  
Iliac Crest ◽  
Iliac Bone ◽  
Bony Union ◽  
Proximal Fragment ◽  
Scaphoid Nonunion ◽  
Level Of Evidence ◽  
Cancellous Bone Grafting ◽  
Vascularized Bone

We present the surgical outcomes of non-vascularized bone grafting taken from the iliac crest in 24 patients with scaphoid nonunion and avascular necrosis. The Fisk-Fernandez technique was used in 11 patients, and cancellous bone grafting was used in 13 patients. Bony union was achieved in 22 of the 24 patients. Non-vascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. Although revascularization of the proximal fragment after surgery was not evaluated, bony union was confirmed in nearly all patients. Level of evidence: IV

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 Arthroscopic Bone Grafting and Kirschner-Wires Fixation for Scaphoid Nonunion

2020 ◽  
Vol 25 (2) ◽  
pp. 90-100
Author(s):  
Young Keun Lee ◽  
Mooheon Jeon ◽  
Ha Song Lee
Keyword(s):  
Minimally Invasive ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Surgical Techniques ◽  
Surgical Trauma ◽  
Percutaneous Fixation ◽  
Cancellous Bone Graft ◽  
Scaphoid Nonunion ◽  
Kirschner Wires ◽  
Vascularized Bone

Various surgical techniques, such as corticocancellous or cancellous bone graft and other vascularized bone grafting techniques have been developed to treat scaphoid nonunion. However, open grafting with dissection of wrist capsule and ligaments damages the joint and hence can lead to increased stiffness of the wrist and hand. Arthroscopic assisted bone grafting and percutaneous fixation have advantages such as minimal surgical trauma to the scaphoid blood supply and its ligament connection and provide a thorough wrist assessment, comprehensive approach for scaphoid nonunion and its sequelae in a minimally invasive manner. This article briefly discusses the characteristic anatomy of the wrist and scaphoid, and reviews the technique of arthroscopic bone grafting and percutaneous fixation for the treatment of scaphoid nonunion.

scholarly journals Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jung-Pan Wang ◽  
Hui-Kuang Huang ◽  
Jui-Tien Shih
Keyword(s):  
Fracture Healing ◽  
Grip Strength ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Healing Time ◽  
The Body ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Wrist Flexion ◽  
Radiographic Outcomes

Abstract Background There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint. Methods Between 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain. Results Nineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24–120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5o to 67.4o, wrist extension from 62.3o to 71.7o, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82o to 66o. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups. Conclusions Using arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.

scholarly journals Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

Cartilage ◽  
2019 ◽  
pp. 194760351987085 ◽  
Author(s):  
Anthony Fiegen ◽  
Devin P. Leland ◽  
Christopher D. Bernard ◽  
Aaron J. Krych ◽  
Jonathan D. Barlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Reported Outcomes ◽  
Glenohumeral Joint ◽  
Meta Analysis ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Cartilage Defects ◽  
Imaging Findings ◽  
Level Of Evidence ◽  
Patient Reported

Objective To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence Level IV.

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