Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

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Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis. [Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis ]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2019.84.1.786 ◽

2019 ◽

Vol 84 (1) ◽

pp. 46-54

Author(s):

Ignacio Rellán ◽

Gerardo Luis Gallucci ◽

Jorge Guillermo Boretto ◽

Agustín Donndorff ◽

Ezequiel Ernesto Zaidenberg ◽

...

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Core Decompression ◽

Fracture Site ◽

Average Score ◽

X Rays ◽

Scaphoid Nonunion ◽

Proximal Pole ◽

Reliable Technique ◽

Pain At Rest

Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado.Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH.Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8.Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. ABSTRACTObjective: To report the consolidation rate and the outcomes of a series of 22 patientswith proximal pole scaphoid nonunion treated with a metaphyseal core decompressionand an anterograde self-compressing screw.Methods: We present a prospective series of patients with proximal pole scaphoidnonunion and confirmation of intraoperative bleeding in both fragments. Patientspresenting with displacement, degenerative changes, proximal pole fragmentation,cavitation at the fracture site, reduced bone length, and necrosis, as well as those withcarpal instability, were excluded. X-rays and computed tomography scans wereperformed to assess consolidation; range of motion and grip strength were recorded, andpatients completed a visual analogue scale for pain at rest, pain during activity, andsubjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder andHand) questionnaire.Results: Eighteen patients were included. Union was observed in 17 patients. Theaverage follow-up time was 22 months, and the average final range of motion was asfollows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnardeviation, and 85% for grip strength. The average score on the visual analogue scalewas 0 for pain at rest, 2 for pain during activity, and 9 for function, while the averageDASH score was 8.Conclusions: Using this simple and reliable technique, we obtained a 95% union andvery good functional results. Metaphyseal core decompression with an antegrade screwis a valid and effective alternative for treatment of proximal pole scaphoid nonunion incarefully selected patients.

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Medial Femoral Condyle Periosteal Free Flap for the Treatment of Talus Avascular Necrosis

Foot & Ankle International ◽

10.1177/1071100720917158 ◽

2020 ◽

Vol 41 (6) ◽

pp. 728-734

Author(s):

Adam Saad ◽

Megan L. Jimenez ◽

Ryan G. Rogero ◽

Sherif Saad ◽

Michael N. Nakashian ◽

...

Keyword(s):

Avascular Necrosis ◽

Free Flap ◽

Femoral Condyle ◽

Case Series ◽

Core Decompression ◽

Free Flaps ◽

Medial Femoral Condyle ◽

Joint Effusion ◽

X Rays ◽

Level Of Evidence

Background: In patients with avascular necrosis (AVN) of the talus in the precollapse stage unresponsive to conservative measures, joint preservation should be considered. Good results have previously been reported for vascularized bone grafting. The medial femoral condyle (MFC) free flap has recently been introduced, which consists of corticoperiosteal bone. We present a novel surgical technique using a periosteal-only MFC (pMFC) free flap in the treatment of talus AVN. Methods: We retrospectively reviewed all pMFC free flaps performed from 2016 to 2018 in the precollapse stage of talus AVN. Surgical management included an ankle arthroscopy, talus core decompression, and ipsilateral pMFC free flap to the talus. Foot and Ankle Ability Measure (FAAM)–Activities of Daily Living (ADL) and visual analog scale (VAS) pain scores were evaluated, and pre- and postoperative imaging studies were assessed by a musculoskeletal-trained radiologist for all patients. Six pMFC free flaps in 5 patients were included in this case series. AVN etiology included idiopathic, posttraumatic, and sepsis-related treatment. All patients were female with an average age of 44.2 (range, 37-67) years. Average postoperative follow-up was 16.9 (range, 6-28) months. Results: Pre- to postoperative FAAM-ADL, ADL single assessment numeric evaluation, and VAS scores showed statistically significant improvement ( P < .039). No reoperations or flap complications were observed. There was 1 minor complication, which included postoperative paresthesias at the pMFC harvest site. Postoperative x-rays showed no subsequent collapse, and magnetic resonance imaging (MRI) illustrated progressive improvement of bone marrow edema, decreased surrounding areas of AVN, and decreased joint effusion when compared to preoperative MRI. Conclusion: The pMFC free flap is a novel modification of a previously described technique, which appears to have similar results compared to the traditional MFC free flap. It was safe and effective in the short term with excellent clinical and radiographic outcomes. Level of Evidence: Level IV, case series.

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Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

Hand ◽

10.1177/1558944720974120 ◽

2020 ◽

pp. 155894472097412

Author(s):

Matteo Ferrero ◽

Enrico Carità ◽

Francesco Giacalone ◽

Julien Teodori ◽

Alberto Donadelli ◽

...

Keyword(s):

Avascular Necrosis ◽

Early Mobilization ◽

Functional Results ◽

Good Alternative ◽

Proximal Row Carpectomy ◽

Proximal Pole ◽

Subjective Outcomes ◽

Clinical Worsening ◽

Pyrocarbon Implant ◽

Over Time

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

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Clinical, radiological and patient-rated outcome comparison between total and partial ulnar head implants

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211048406 ◽

2021 ◽

pp. 175319342110484

Author(s):

Lea Estermann ◽

Lisa Reissner ◽

Andrea B. Rosskopf ◽

Andreas Schweizer ◽

Ladislav Nagy

Keyword(s):

Grip Strength ◽

Distal Radioulnar Joint ◽

Joint Arthroplasty ◽

Dash Score ◽

Level Of Evidence ◽

Radioulnar Joint ◽

Ulnar Head ◽

Outcome Comparison ◽

Pain At Rest

This study aimed to analyse the clinical and radiological outcomes after ulnar head replacement and to compare partial and total ulnar head implants. Twenty-two patients with 23 implants were available with a mean follow-up time of 7 years (range 1.3 to 17) after distal radioulnar joint arthroplasty. At the final follow-up, patients had a low level of pain at rest and during effort, a median Disabilities of the Arm, Shoulder, and Hand (DASH) score of 12 and Patient-Rated Wrist Evaluation score of 12 with partial ulnar head implants, and scores of 20 and 22 in total ulnar head implants, respectively. While the range of motion in patients with partial ulnar head implants was slightly reduced in comparison with the preoperative condition and to the patients with total ulnar head implants, there was a tendency to a higher grip strength and rotational torque. Both types of prosthesis showed sigmoid notch resorptions and resorptions around the neck. We conclude that the results after partial ulnar head replacement do not significantly differ from the total ulnar head implants in many aspects. Level of evidence: III

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MRI Controlled Metaphyseal Core Decompression of the Distal Radius in Lunate Avascular Necrosis

Hand ◽

10.1177/1558944716660555ia ◽

2016 ◽

Vol 11 (1_suppl) ◽

pp. 119S-119S

Author(s):

Christoph U. Schulz ◽

Nikolaus Hof ◽

Hermann Anetzberger

Keyword(s):

Avascular Necrosis ◽

Distal Radius ◽

Core Decompression

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Pain Management during Rehabilitation after Distal Radius Fracture Stabilized with Volar Locking Plate: A Prospective Cohort Study

BioMed Research International ◽

10.1155/2018/5786089 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Pengbo Luo ◽

Jinjie Lou ◽

Shengwu Yang

Keyword(s):

Pain Management ◽

Distal Radius Fracture ◽

Distal Radius ◽

Locking Plate ◽

Rehabilitation Program ◽

Radius Fracture ◽

Dash Score ◽

Volar Locking Plate ◽

Vas Scores ◽

Pain At Rest

Introduction. Internal fixation with volar locking plate (VLP) was widely adopted as a first-line choice in treatment of distal radius fracture (DRF). Methods. Total 315 patients with distal radius fracture receiving VLP fixation were included for analysis in this study. The rehabilitation protocol was started immediately after surgery for all patients. During the initial two weeks after surgery, 149 patients received 200 mg celecoxib twice per day, 89 received buprenorphine transdermal patch at 5 μg/h, and 77 received 13 mg codeine plus 200 mg ibuprofen twice per day for pain management. Visual analog scale (VAS) scores of pain at rest, daily activity, and rehabilitative exercise were measured, respectively, every week according to the experiences of the past week in the initial six weeks after surgery. Functional outcomes including range of motion (ROM) for extension, flexion, pronation, supination, ulnar and radial abduction, the disabilities of arm, shoulder, and hand (DASH) score and the validated patient rated wrist evaluation (PRWE), and grip strength were collected at one, three, and six months after surgery. Results. We showed that patients receiving transdermal buprenorphine and codeine/ibuprofen had decreased VAS scores during rehabilitative exercise, better compliance to the rehabilitation program, and thus faster functional recovery. Conclusions. We recommend transdermal buprenorphine or codeine/ibuprofen for pain management during rehabilitation after distal radius fracture stabilized with VLP.

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A Retrospective Study in the Treatment of a 2-Part Greater Tuberosity Fracture Using the F3 Biomet Plate

International Surgery ◽

10.9738/intsurg-d-16-00106.1 ◽

2016 ◽

Vol 101 (9-10) ◽

pp. 465-472

Author(s):

Jun Ma ◽

Liangyu Zhao ◽

Tao Liu ◽

Qiang Fu ◽

Aimin Chen

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Constant Score ◽

Shoulder Function ◽

Open Reduction Internal Fixation ◽

Dash Score ◽

X Rays ◽

Level Of Evidence ◽

Greater Tuberosity

The purpose of this study was to evaluate the clinical efficacy of the F3 Biomet plate in the treatment of 2-part displaced humeral greater tuberosity fractures. We compared the clinical outcomes of patients with displaced greater tuberosity fractures who underwent surgical treatment using an F3 plate with those of patients who were treated nonsurgically. Eleven patients with 2-part displaced humeral greater tuberosity fractures were surgically treated with use of an F3 Biomet plate, whereas 12 patients with equal injuries were treated nonsurgically. Each patient underwent follow-up for at least 1 year. We retrospectively collected data and analyzed the clinical outcomes. The Constant score and DASH score were used to assess the shoulder function, and X-rays were taken to evaluate the fracture healing. X-rays of the patients in both groups showed that the fractures achieved union after the 1-year follow-up. Patients treated surgically with an F3 plate and open reduction internal fixation had better Constant score and DASH score results for shoulder function than those treated nonsurgically. In the present study, surgical treatment of displaced humeral greater tuberosity fractures with the use of an F3 plate led to a 100% union rate and good clinical outcomes. The F3 Biomet plate can be considered an effective implant for the treatment of displaced humeral greater tuberosity fractures. The level of evidence is therapeutic III.

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Results of the treatment of distal radius fractures with a proprietary implant, the DRONes nail plate – preliminary report

Chirurgia Narządów Ruchu i Ortopedia Polska ◽

10.31139/chnriop.2020.86.2.6 ◽

2020 ◽

Vol 86 (2) ◽

pp. 66-72

Author(s):

Maciej Piotrowski ◽

Keyword(s):

Distal Radius ◽

Soft Tissues ◽

Full Range ◽

Nail Plate ◽

Functional Results ◽

Distal Radius Fractures ◽

Intramedullary Fixation ◽

X Rays ◽

Radius Fractures ◽

Additional Advantage

Introduction. Distal radius fractures are one of the most common bone injuries. Modern treatment methods are needed not only to reduce the time needed to heal, but also allow the wrist the full range of motion as soon as possible. The solution should provide stable bone fixation with the least possible damage to soft tissues, which will allow quick recovery of extremity function. The method meeting these criteria is intramedullary fixation. Aim of the study. To evaluate the treatment results of distal radius fractures with the DRONes® hybrid nail plate. Material and methods. The study group consists of patients with distal radius fracture treated with open reduction and intramedullary fixation. Patients aged 24 to 69 years (average 54 years) were operated on after a failed attempt to adjust the fracture using the closed reduction method. 40 distal fractures of the distal radius qualified for the following 5 types according to AO: 2 fractures -A2, 5 -A3, 8 -C1, 14 -C2, 11 -C3. Two weeks after the surgery, X-rays were performed to check the position of the bone fragments and implant. After a further 6-7 weeks, the union and wrist function were evaluated. Results. Bone union was achieved in all patients within 8-9 weeks, and the range of wrist mobility was only slightly limited. The most common complication was the neurapraxia of the superficial branch of the radial nerve disappearing after 6-8 weeks. Conclusions. Patients treated with the DRONes® hybrid nail plate achieve good functional results after 8-9 weeks and can return to work and their preinjury lifestyle. An additional advantage is the simple surgical technique.

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

Injury ◽

10.1016/j.injury.2021.04.016 ◽

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

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Primary Vascularized Distal Radius Bone Graft for Nonunion of the Scaphoid

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0378 ◽

2000 ◽

Vol 25 (3) ◽

pp. 266-270 ◽

Cited By ~ 58

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.

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