Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

scholarly journals Current Management of Scaphoid Nonunion Based on the Biomechanical Study

2018 ◽  
Vol 07 (02) ◽  
pp. 094-100 ◽  
Author(s):  
Kunihiro Oka ◽  
Hisao Moritomo
Keyword(s):  
Natural History ◽  
Biomechanical Study ◽  
Distal Fragment ◽  
Scaphoid Nonunion ◽  
Degenerative Arthritis ◽  
Carpal Collapse ◽  
Interosseous Ligament ◽  
History Of ◽  
Dorsal Intercalated Segment Instability

AbstractScaphoid nonunion causes abnormal wrist kinematics and typically leads to carpal collapse and subsequent degenerative arthritis of the wrist. However, the natural history, including carpal collapse and degenerative arthritis of scaphoid nonunion, may vary at different fracture locations. This article reviews recent biomechanical studies related to the natural history of scaphoid nonunion. In the distal-type fractures (type B2 in Herbert classification), where the fracture located distal to the scaphoid apex, the proximal scaphoid fragment and lunate, which are connected through the dorsal scapholunate interosseous ligament (DSLIL) and dorsal intercarpal ligament (DIC), extend together, and the distal fragment of the scaphoid flexes individually. Therefore, untreated type B2 fractures normally show the humpback deformity, resulting in dorsal intercalated segment instability deformity relatively earlier after the injury. In the proximal-type fractures (type B1), where the fracture is located proximal to the scaphoid apex, the connection between the distal fragment and lunate is preserved through the DSLIL and DIC so that the scaphoid–lunate complex remains stable and the carpal collapse is less severe than that in distal-type fractures. The fracture location relative to the apex of the dorsal scaphoid ridge is a reliable landmark in the determination of the natural history of scaphoid nonunion.

Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Nicholas H. Lake ◽  
Rafae Khan ◽  
Kyle W. Mombell ◽  
Mary Fergus ◽  
Dominic Gomez-Leonardelli
Keyword(s):  
Functional Outcome ◽  
Military Service ◽  
Functional Outcomes ◽  
High Rate ◽  
Scaphoid Nonunion ◽  
Military Population ◽  
Outcome Scores ◽  
The Mean ◽  
Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

scholarly journals SOD1 Mutation Spectrum and Natural History of ALS Patients in a 15-Year Cohort in Southeastern China

2021 ◽  
Vol 12 ◽  
Author(s):  
Lu-Xi Chen ◽  
Hai-Feng Xu ◽  
Pei-Shan Wang ◽  
Xin-Xia Yang ◽  
Zhi-Ying Wu ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Natural History ◽  
Diagnostic Delay ◽  
Mutation Spectrum ◽  
Survival Duration ◽  
Southeastern China ◽  
History Of ◽  
Male Patients ◽  
The Mean ◽  
Als Patients

Background: Mutations in superoxide dismutase 1 gene (SOD1) are the most frequent high penetrant genetic cause for amyotrophic lateral sclerosis (ALS) in the Chinese population. A detailed natural history of SOD1-mutated ALS patients will provide key information for ongoing genetic clinical trials.Methods: We screened for SOD1 mutations using whole exome sequencing (WES) in Chinese ALS cases from 2017 to 2021. Functional studies were then performed to confirm the pathogenicity of novel variants. In addition, we enrolled previously reported SOD1 mutations in our centers from 2007 to 2017. The SOD1 mutation spectrum, age at onset (AAO), diagnostic delay, and survival duration were analyzed.Results: We found two novel SOD1 variants (p.G17H and p.E134*) that exerted both gain-of-function and loss-of-function effects in vitro. Combined with our previous SOD1-mutated patients, 32 probands with 21 SOD1 mutations were included with the four most frequently occurring mutations of p.V48A, p.H47R, p.C112Y, and p.G148D. SOD1 mutations account for 58.9% of familial ALS (FALS) cases. The mean (SD) AAO was 46 ± 11.4 years with a significant difference between patients carrying mutations in exon 1 [n = 5, 34.6 (12.4) years] and exon 2 [n = 8, 51.4 (8.2) years] (p = 0.038). The mean of the diagnostic delay of FALS patients is significantly earlier than the sporadic ALS (SALS) patients [9.5 (4.8) vs. 20.3 (9.3) years, p = 0.0026]. In addition, male patients survived longer than female patients (40 vs. 16 months, p = 0.05).Conclusion: Our results expanded the spectrum of SOD1 mutations, highlighted the mutation distribution, and summarized the natural history of SOD1-mutated patients in southeastern China. Male patients were found to have better survival, and FALS patients received an earlier diagnosis. Our findings assist in providing a detailed clinical picture, which is important for ongoing genetic clinical trials.

The Natural History of Post-Traumatic Reflex Sympathetic Dystrophy

1998 ◽  
Vol 23 (1) ◽  
pp. 20-23 ◽  
Author(s):  
A. ZYLUK
Keyword(s):  
Natural History ◽  
Grip Strength ◽  
Reflex Sympathetic Dystrophy ◽  
Prospective Trial ◽  
Signs And Symptoms ◽  
Final Assessment ◽  
Functionally Impaired ◽  
History Of ◽  
Post Traumatic

The paper presents the results of a prospective trial to examine the natural history of early reflex sympathetic dystrophy (RSD). Thirty patients with post-traumatic RSD of the hand were observed without treatment. They were reassessed 1, 2 and 6 months after diagnosis with a final assessment at 10 to 18 months (average 13 months). Twenty-seven patients completed the study. Three were withdrawn during the study because of persistence of signs and symptoms of RSD and were given further treatment. Of the 27 patients who completed the study, only one showed sufficient features of the condition to warrant the diagnosis of mild RSD. In the remaining 26, most features of RSD had resolved spontaneously. Pain and swelling disappeared more quickly than other features of RSD. Although the signs and symptoms of RSD had largely gone at 13 months, the hands were still functionally impaired because of weaker grip strength.

Use of Vascularized Fibular Free Flap in the Reconstruction of the Femur in Pediatric and Adolescent Bone Sarcomas: Complications and Functional Outcome

2018 ◽  
Vol 35 (02) ◽  
pp. 156-162 ◽  
Author(s):  
Magdy Sherbiny ◽  
Nehal Kamal ◽  
Ahmed Ghoneimy
Keyword(s):  
Functional Outcome ◽  
Free Flap ◽  
Average Length ◽  
Femoral Shaft ◽  
Wide Resection ◽  
Level Of Evidence ◽  
Bone Sarcomas ◽  
Fibular Free Flap ◽  
The Mean ◽  
Resected Femoral

Background Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. Methods Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap. All clinical and radiographic data were reviewed for graft healing and hypertrophy as well as oncologic and functional outcome. Results The mean follow-up period was 48.7 months (12–104 months). The mean age at presentation was 10.3 years (5–17 years). The average length of the resected femoral shaft was 19.2 cm (15–24 cm) and the average length of the harvested fibula was 17.4 cm (15–21 cm). The mean time to union was 4.8 months (1–6 months) and the mean hypertrophy index was 78% (15.5–184%). Complications included 12 fractures (33.3%), 5 non-unions (13.8%), and 5 failures of graft hypertrophy (13.8%). At the latest clinical evaluation, the mean MSTS score was 81% (56–100%) and the mean limb length inequality was 4.75 cm (3–11 cm). Conclusion Despite the high functional demand and deleterious effect of chemotherapy on bone healing, reconstruction of the femur by vascularized fibular free flap in pediatric bone sarcomas can lead to a good functional outcome. Complications, such as fracture and non-union, can be successfully treated by revision of fixation and autologous iliac crest grafting. Level of Evidence IV.

Abstract TP397: Clinical And Functional Outcome Of Adult Patients Diagnosed With Moyamoya Disease In Childhood

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Fam ◽  
Nomazulu Dlamini ◽  
Cheryl Jaigobin
Keyword(s):  
Ischemic Stroke ◽  
North America ◽  
Natural History ◽  
Functional Outcome ◽  
Moyamoya Disease ◽  
Vascular Event ◽  
Moyamoya Syndrome ◽  
The Mean

Background: Moyamoya disease is a progressive occlusive arteriopathy of the terminal ICA and its branches, leading to the formation of unstable collateral vessels. The disease is found worldwide, and is associated with a number of predisposing conditions, termed moyamoya syndrome. Currently there is a paucity of data on the natural history of moyamoya disease in North America, especially the long-term outcome of pediatric moyamoya. Objective: Our objectives were to determine the rate of recurrent TIA, ischemic stroke and intracerebral hemorrhage in patients presenting with pediatric Moyamoya disease and to assess long-term functional outcome. Methods: This study was a retrospective chart review of 52 patients presenting with pediatric moyamoya disease. We included patients aged 18 or older with a diagnosis of moyamoya disease or syndrome. All patients had confirmatory baseline vascular imaging (MRA or CTA +/- cerebral angiography). Baseline demographic variables and annual vascular event recurrence risk were obtained from the records. Modified Rankin Score (MRS) at presentation and last follow-up were determined from clinical records. Results: Of the original cohort, 34 patients were included for analysis. The mean age of the patients was 23.9 years. The mean age at presentation was 9 years (SD=4) with an average follow-up of 11.3 years (SD=5.1) for a total of 383 patient years. There was slight female predominance (1.4:1). Fifty percent of patients (17) presented with ischemic stroke. A total of 26 patients (76%) underwent surgery, with 7 (21%) requiring repeat surgery. The annual vascular recurrent event rate was 5.0% (19/383), which was not significantly different between surgical and non-surgical groups or between different moyamoya syndrome subtypes. Most of the recurrent events were TIA (annual recurrence 3.7%). There was no significant difference between initial MRS, MRS at last follow-up and mean change in MRS between surgical and non-surgical groups. Conclusion: Our study is the largest North American natural history study of pediatric moyamoya. Our observations indicate that pediatric moyamoya in North America have low recurrent vascular event rates and long-term functional outcomes are good, even in conservatively managed patients.

CLINICAL OUTCOMES OF PATIENTS UNDERGOING CORRECTION OF NEUROMUSCULAR SCOLIOSIS WITH A CONTROLLED HOSPITAL PROTOCOL – PRELIMINAR OUTCOMES

2021 ◽  
Vol 20 (4) ◽  
pp. 249-253
Author(s):  
Gabriela Alcalde Pereira ◽  
Caroline de Carvalho Garcia ◽  
Marcia Almeida Lima ◽  
José Carlos Baldocchi Pontin ◽  
Andrea Dias Lamas Mafra
Keyword(s):  
Retrospective Study ◽  
Surgical Correction ◽  
Neuromuscular Scoliosis ◽  
Complication Rates ◽  
Level Of Evidence ◽  
The Mean ◽  
Underlying Diseases ◽  
Level Hospital ◽  
Epidemiological Characterization

ABSTRACT Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

scholarly journals The Natural History of Ossification of Yellow Ligament of the Thoracic Spine on MRI: A Population-Based Cohort Study

2020 ◽  
pp. 219256822090376 ◽  
Author(s):  
Chris Yuk Kwan Tang ◽  
Kenneth Man Chee Cheung ◽  
Dino Samartzis ◽  
Jason Pui Yin Cheung
Keyword(s):  
Cohort Study ◽  
Natural History ◽  
Thoracic Spine ◽  
Population Based ◽  
Close Monitoring ◽  
Level Of Evidence ◽  
Southern Chinese ◽  
History Of ◽  
Prospective Longitudinal

Purpose: To assess the natural history of ossification of yellow ligament (OYL) in the thoracic spine and determine risk factors for progression based on a longitudinal population-based cohort. Methods: A prospective, longitudinal cohort study was performed on a population-based cohort of Southern Chinese volunteers. T2-weighted magnetic resonance imaging (MRI) was used at baseline to identify any OYL and was verified with computed tomography. Follow-up MRI was performed 5 years later. Parameters under study included the size of OYL, levels of involvement, morphology (round, triangular, beak), whether it crossed the midline and any disc degeneration. Results: A total of 114 (6.1%) individuals were identified to have OYL at baseline out of the 1864 individuals. Size progression occurred predominantly at the lower thoracic region. Majority of the new OYL were also in the lower thoracic spine and was associated with higher body mass index (BMI). Smokers were associated with OYL size progression while patients with higher BMI tended to develop new OYL at follow-up. Progression commonly occurred at the lower thoracic levels and regression occurred mostly at the upper thoracic levels. Conclusions: This is the first population-based series addressing the natural history of OYL. Better understanding of the natural history of OYL may provide incentive to introduce preventive measures such as weight reduction and close monitoring for myelopathy development in those at-risk groups for progression. This is especially important for patients with lower thoracic OYL and who are smokers with higher BMI. Level of Evidence: 1 (prognostic study).

Radiographic Value of the Lisfranc Diastasis in a Standardized Population

2019 ◽  
Vol 13 (6) ◽  
pp. 494-501 ◽  
Author(s):  
James L. Thomas ◽  
Adam Kopiec ◽  
Kunkel Mark ◽  
L. Mae Chandler
Keyword(s):  
Systemic Disease ◽  
Lisfranc Joint ◽  
Level Of Evidence ◽  
Female Population ◽  
Entire Study ◽  
Medial Cuneiform ◽  
Joint Width ◽  
History Of ◽  
The Mean ◽  
Lisfranc Injuries

Introduction. Injury to the Lisfranc’s joint, in particular to the second metatarsal–medial cuneiform (second MMC) joint, can be difficult to evaluate, especially in subtle Lisfranc injuries. The purpose of this study was to determine the value of the Lisfranc joint width (diastasis) of the adult foot in a standardized population thereby establishing a potential reference range when investigating this area for potential injury. Methods. The 2nd MMC joint in 50 men and 50 women was evaluated. Individuals with a history of foot/ankle pain, previous foot/ankle operation or fracture, or a history of systemic disease were excluded from the study. Bilateral weightbearing digital anterior-posterior and lateral radiographs were taken using a standardized method. Results. The mean 2nd MMC diastasis in 200 feet was 5.6 mm (95% CI 5.39-5.81). In the female population, the mean 2nd MMC diastasis was 5.8 mm (95% CI 5.51-6.09) as compared with 5.6 mm (95% CI 5.31-5.89) in males. The mean distance between the fifth metatarsal base and first cuneiform in the entire study population was 16.3 mm (95% CI 15.57-17.03). Conclusion. This study helps define baseline measurements of the Lisfranc joint for the general population, which can provide a standard measurement against which suspected foot injuries can be compared. Level of Evidence: Level IV.

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