THE USE OF BMP-2 AND SCREW EXCHANGE IN THE TREATMENT OF SCAPHOID FRACTURE NON-UNION

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 167-171 ◽  
Author(s):  
Robert H. Ablove ◽  
Samuel S. Abrams
Keyword(s):  
Internal Fixation ◽  
Scaphoid Fracture ◽  
Clinical Problem ◽  
Bony Union ◽  
Proximal Pole ◽  
Union Rate ◽  
Non Union ◽  
Scaphoid Fractures ◽  
Number Of Patients ◽  
Vexing Problem

Scaphoid non-union, particularly following internal fixation, is a vexing problem. A retrospective review was conducted analysing the outcome of 4 patients who failed initial open reduction and internal fixation of scaphoid fractures. Three fractures were located in the waist and the fourth in the proximal pole. All patients underwent screw exchange and Bone Morphogenic Protein (BMP)-2 sponge placement with no additional bone grafting. Patients were immobilised for 4 weeks and followed with serial radiographs in all cases and CT scans in 3 cases. All patients demonstrated evidence of bony union at an average of 53 days from surgery and ultimately returned to pain-free full activity. There were no complications. BMP-2 and screw exchange yielded a 100% union rate in patients with established scaphoid non-union. While this retrospective study represents a small number of patients and clearly requires further investigation, it presents a promising technique for managing a difficult clinical problem.

Gadolinium Enhanced Mr Assessment of Proximal Fragment Vascularity in Nonunions after Scaphoid Fracture: Does It Predict the Outcome of Reconstructive Surgery?

2004 ◽  
Vol 29 (5) ◽  
pp. 444-448 ◽  
Author(s):  
A.K. SINGH ◽  
T.R.C. DAVIS ◽  
J.S. DAWSON ◽  
J.A. ONI ◽  
N.D. DOWNING
Keyword(s):  
Internal Fixation ◽  
Reconstructive Surgery ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Proximal Pole ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
Fracture Nonunions ◽  
Outcome Of Surgery ◽  
Mr Scanning

This study investigated whether the outcome of bone graft and internal fixation surgery for nonunion of scaphoid fractures could be predicted by gadolinium-enhanced MR assessments of proximal fragment vascularity. Sixteen established scaphoid fracture nonunions underwent gadolinium-enhanced MR scanning before surgical treatment with bone grafting and internal fixation. No relationship was found between MR enhancement and the outcome of surgery. Union was achieved in eight of the 12 nonunions with more than 50% enhancement, and three of the four with less than 50% enhancement, of the proximal pole. Furthermore, union was achieved in both of the nonunions which had less than 25% enhancement of the proximal pole. We conclude that enhanced MR assessments of the vascularity of the proximal fragment of a scaphoid fracture nonunion do not accurately predict the outcome of reconstructive surgery.

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.

A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Syed Shumon ◽  
Moin Durrani ◽  
Karthikeyan P. Iyengar ◽  
William Y. C. Loh
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Carpal Bone ◽  
Non Union ◽  
Scaphoid Fractures ◽  
First Case ◽  
Vascularized Bone ◽  
Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

Consequences of Late Immobilization of Scaphoid Fractures

1988 ◽  
Vol 13 (1) ◽  
pp. 77-79
Author(s):  
O. LANGHOFF ◽  
J. L. ANDERSEN
Keyword(s):  
Delayed Union ◽  
Bony Union ◽  
Proximal Pole ◽  
Non Union ◽  
Scaphoid Fractures ◽  
The Relationship

In order to determine the relationship between delay before immobilization and the development of non-union or delayed union, 285 fractures of the scaphoid have been analysed from records and radiographs. 16 non-unions and 25 of 27 fractures with delayed union were found in proximal pole or waist fractures in adults, which were analyzed separately. No increment in the time to bony union or in the incidence of non-union was found following a delay of immobilization of less than four weeks, but when the delay exceeded four weeks, most fractures had healing complications.

Real Time Ultrasonography in the Assessment of Movement at the Site of a Scaphoid Fracture Non-Union

1994 ◽  
Vol 19 (4) ◽  
pp. 498-504 ◽  
Author(s):  
J. J. DIAS ◽  
A. C. W. HUI ◽  
A. C. LAMONT
Keyword(s):  
Surgical Treatment ◽  
Real Time ◽  
Scaphoid Fracture ◽  
Fracture Site ◽  
Proximal Pole ◽  
Non Union ◽  
Non Invasive ◽  
Scaphoid Fractures ◽  
Time Linear ◽  
Real Time Ultrasonography

We investigated the use of real time linear ultrasonography in determining movement at a scaphoid fracture site in 27 patients with non-united scaphoid fractures. 24 of these patients had surgical treatment. Fracture movement was observed at the time of surgery and this was compared with the ultrasonographic findings. The technique proved to be 100% specific for visualization of movement at the fracture site and it was non-invasive. However, it was of no benefit in assessing proximal pole non-union.

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

scholarly journals The Clinical Scaphoid Fracture: Early Computed Tomography as a Practical Approach

2008 ◽  
Vol 90 (6) ◽  
pp. 488-491 ◽  
Author(s):  
Q Nguyen ◽  
S Chaudhry ◽  
R Sloan ◽  
I Bhoora ◽  
C Willard
Keyword(s):  
Ct Scan ◽  
General Hospital ◽  
Scaphoid Fracture ◽  
False Negative ◽  
False Negative Rate ◽  
District General Hospital ◽  
X Rays ◽  
Fracture Clinic ◽  
Non Union ◽  
Scaphoid Fractures

INTRODUCTION Up to 40% of scaphoid fractures are missed at initial presentation as clinical examination and plain radiographs are poor at identifying scaphoid fractures immediately after the injury. Avoiding a delay in diagnosis is essential to prevent the risk of non-union and early wrist arthritis. We demonstrate the use of CT scanning for the early confirmation of a scaphoid fracture. PATIENTS AND METHODS We conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a small district general hospital. We performed a CT scan on all ‘clinical scaphoid’ patients who had negative plain X-ray films. RESULTS Overall, 70% of patients had a CT scan within 1 week of injury and not from date of accident and emergency attendance; 83% of patients had a CT scan within 2 weeks of injury. Of 118 patients identified, 32% had positive findings and 22% of ‘clinical scaphoid’ patients had scaphoid fractures. The proportion of positive findings for an acute scaphoid fracture was 68%. Additional pathologies identified on CT were capitate, triquetral and radial fractures. CONCLUSIONS Our audit shows that it is practical to perform CT on suspicious scaphoid fractures in a small district general hospital. We identified an extremely high false-negative rate for plain X-rays and demonstrate that the appropriate use of CT at initial fracture clinic attendance with ‘clinical scaphoid’ leads to an earlier diagnosis and reduces the need for prolonged immobilisation and repeated clinical review.

Early results of a new implant: 3.0 mm headless compression screw for scaphoid fracture fixation

2012 ◽  
Vol 37 (7) ◽  
pp. 690-693 ◽  
Author(s):  
K. Singisetti ◽  
E. Aldlyami ◽  
A. Middleton
Keyword(s):  
Internal Fixation ◽  
Fracture Fixation ◽  
Scaphoid Fracture ◽  
Compression Screw ◽  
Headless Compression Screw ◽  
Scaphoid Fractures ◽  
Early Results ◽  
Fracture Nonunions ◽  
Radiological Healing ◽  
Vascularized Bone

There has been a considerable evolution of screws used for internal fixation of scaphoid fractures. We discuss here, early results of a recently introduced implant Synthes 3.0 mm headless compression screw used for scaphoid fracture fixation. Twenty eight patients with scaphoid fractures (five acute and 23 nonunions) were treated with internal fixation by this non-variable pitch screw over a period of 18 months. All nonunions had pedicle vascularized bone grafting. All five patients with acute scaphoid fracture fixation had radiological healing at a mean of 8 weeks. Fifteen of 23 scaphoid fracture nonunions showed definite signs and a further seven showed probable signs of radiological healing at a mean of 8 months. One nonunion has failed to unite after surgery.

Postoperative Cast Necessity after a Lapidus Arthrodesis

2009 ◽  
Vol 30 (8) ◽  
pp. 746-751 ◽  
Author(s):  
Sarmad Kazzaz ◽  
Dishan Singh
Keyword(s):  
Internal Fixation ◽  
Hallux Valgus ◽  
Surface Preparation ◽  
Bone Surface ◽  
Union Rate ◽  
Bone Resection ◽  
Superficial Wound Infection ◽  
Non Union ◽  
Superficial Wound ◽  
First Ray

Background: The incidence of non union following a first tarsometatarsal arthrodesis (Lapidus procedure) has decreased significantly with modern techniques of minimal bone resection, meticulous bone surface preparation and rigid internal fixation. We evaluated whether a postoperative wedge shoe would increase our non-union rate. Materials and Methods: Nineteen adult female patients (27 feet; eight bilateral, five simultaneous) undergoing a first tarsometatarsal arthrodesis for hallux valgus associated with a hypermobile first ray or for recurrent hallux valgus were managed postoperatively by allowing them to bear weight in a wedge shoe instead of a cast. Radiographs were evaluated for signs of fusion. Results: All 27 feet went on to successful union after 6 to 24 weeks. There was one superficial wound infection and one case of recurrence of the hallux valgus. Conclusion: Based on our results, we allow adult patients undergoing a Lapidus type procedure to be managed in a postoperative wedge shoe.

scholarly journals Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification

2019 ◽  
Vol 08 (06) ◽  
pp. 446-451
Author(s):  
Tessa Drijkoningen ◽  
Amin Mohamadi ◽  
Wouter F. van Leeuwen ◽  
Yonatan Schwarcz ◽  
David Ring ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Interobserver Reliability ◽  
Scaphoid Fracture ◽  
Fracture Classification ◽  
Proximal Pole ◽  
Level Of Evidence ◽  
Related Factors ◽  
Scaphoid Fractures ◽  
Fracture Patterns

Abstract Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification (P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.

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