scholarly journals The outcome of bone graft surgery for nonunion of fractures of the scaphoid

2019 ◽  
Vol 44 (7) ◽  
pp. 676-684 ◽  
Author(s):  
Mohannad B. Ammori ◽  
Michael Elvey ◽  
Samer S. Mahmoud ◽  
Alex J. Nicholls ◽  
Simon Robinson ◽  
...  
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Scaphoid Fracture ◽  
Sufficient Data ◽  
Level Of Evidence ◽  
Significance Level ◽  
The United Kingdom ◽  
Union Status ◽  
Fracture Nonunion ◽  
Outcome Of Surgery

Data on 806 patients undergoing bone graft surgery for a scaphoid fracture nonunion were retrospectively collected at 19 centres in the United Kingdom. Each centre contributed at least 30 cases. Sufficient data were available in 462 cases to study factors that influenced the outcome of surgery. Overall union occurred in at least 69%, and nonunion in at least 22%, with 9% of cases having ‘uncertain union status’. Union appeared to be adversely influenced by smoking and the time between acute scaphoid fracture and nonunion surgery, with adjusted odds ratios of 1.8 and 2.4, respectively, but neither achieved the pre-determined significance level of 0.003. The type of bone graft (vascular vs non-vascular; iliac crest vs distal radius) did not appear to influence outcome. Further large multicentre prospective studies with clear definitions of ‘union’ and other factors are needed to clarify whether modification of surgical technique can influence union. Level of evidence: IV

Dorsal intercalated segmental instability associated with malunion of a reconstructed scaphoid

2016 ◽  
Vol 42 (3) ◽  
pp. 240-245 ◽  
Author(s):  
J.-H. Kim ◽  
K.-H. Lee ◽  
B. G. Lee ◽  
C.-H. Lee ◽  
S.-J. Kim ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Length Ratio ◽  
Receiver Operating Curve ◽  
Flexion Deformity ◽  
Level Of Evidence ◽  
Tomographic Images ◽  
Segmental Instability ◽  
Computed Tomographic ◽  
Receiver Operating Curve Analysis ◽  
Fracture Nonunion

We analysed scaphoid deformity as a result of surgical treatment of scaphoid fracture nonunion and assessed the deformity associated with a dorsal intercalated segmental instability pattern of carpal malalignment. A total of 45 patients who were treated for scaphoid fracture nonunion were included in the study. The height-to-length ratio of the scaphoid was measured on computed tomographic images and used to assess scaphoid deformity. Carpal malalignment was quantified based on the radio-lunate angle. A correlation analysis between the height-to-length ratio and the radio-lunate angle was performed. Dorsal intercalated segmental instability was defined as a radio-lunate angle >15°, and a receiver operating curve analysis was used to calculate the cutoff height-to-length ratio that can be accompanied with dorsal intercalated segmental instability. Extension of the lunate increases in proportion to the flexion deformity of the scaphoid; dorsal intercalated segmental instability can occur if the height-to-length ratio of the scaphoid is >0.73. Level of evidence: IV

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.

Cartilage Morphological and Histological Findings After Reconstruction of the Glenoid With an Iliac Crest Bone Graft

2018 ◽  
Vol 46 (5) ◽  
pp. 1039-1045 ◽  
Author(s):  
Alexander Auffarth ◽  
Herbert Resch ◽  
Nicholas Matis ◽  
Martin Hudelmaier ◽  
Wolfgang Wirth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Graft ◽  
Iliac Crest ◽  
Histological Analysis ◽  
Case Series ◽  
Bone Grafts ◽  
Iliac Crest Bone Graft ◽  
Level Of Evidence ◽  
Biopsy Specimens ◽  
Magnetic Resonance Imaging Mri

Background: The J-bone graft is presumably representative of iliac crest bone grafts in general and allows anatomic glenoid reconstruction in cases of bone defects due to recurrent traumatic anterior shoulder dislocations. As a side effect, these grafts have been observed to be covered by some soft, cartilage-like tissue when arthroscopy has been indicated after such procedures. Purpose: To evaluate the soft tissue covering of J-bone grafts by use of magnetic resonance imaging (MRI) and histological analysis. Study Design: Case series; Level of evidence, 4. Methods: Patients underwent MRI at 1 year after the J-bone graft procedures. Radiological data were digitally processed and evaluated by segmentation of axial images. Independent from the MRI analysis, 2 biopsy specimens of J-bone grafts were harvested for descriptive histological analysis. Results: Segmentation of the images revealed that all grafts were covered by soft tissue. This layer had an average thickness of 0.87 mm compared with 1.96 mm at the adjacent native glenoid. Of the 2 biopsy specimens, one exhibited evident hyaline-like cartilage and the other presented patches of chondrocytes embedded in a glycosaminoglycan-rich extracellular matrix. Conclusion: J-bone grafts are covered by soft tissue that can differentiate into fibrous and potentially hyaline cartilage. This feature may prove beneficial for delaying the onset of dislocation arthropathy of the shoulder.

Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft

2015 ◽  
Vol 41 (5) ◽  
pp. 492-500 ◽  
Author(s):  
D. O. Ferguson ◽  
V. Shanbhag ◽  
H. Hedley ◽  
I. Reichert ◽  
S. Lipscombe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Graft ◽  
Study Design ◽  
Scaphoid Fracture ◽  
Vascularized Bone Graft ◽  
Level Of Evidence ◽  
Data Set ◽  
Non Union ◽  
Quality And Outcomes ◽  
Vascularized Bone

This systematic review assesses the quality and outcomes of published articles concerning bone graft surgery for scaphoid fracture non-union. Searches of the CENTRAL, MEDLINE, EMBASE, CINAHL and AMED databases captured 2710 articles. Each article was screened and 144 met our inclusion criteria. Data regarding source, study design, population, intervention, comparator and outcomes were extracted. There were 5464 scaphoid non-union outcomes within the 144 studies. Mean reported union rates for vascularized and non-vascularized bone graft were 84% and 80%, respectively. Avascular necrosis was diagnosed in several ways and, when present, the vascularized bone graft union rate was 74% compared with 62% with non-vascularized bone graft. Reported union rates vary considerably. These differences may be due to patient factors, fracture factors, treatment factors or study design failures or bias. We recommend that future researchers take into account the deficiencies of previous studies and use the suggested minimum data set in future studies. Level of evidence: II

scholarly journals Pronator quadratus pedicled bone graft for scaphoid non-unions

2020 ◽  
Vol 7 (10) ◽  
pp. 3414
Author(s):  
Harsha Vardhan ◽  
Anto Francis
Keyword(s):  
Bone Graft ◽  
Fracture Healing ◽  
Scaphoid Fracture ◽  
Fracture Site ◽  
Vascularized Bone Graft ◽  
Proximal Pole ◽  
Pronator Quadratus ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
Vascularized Bone

Scaphoid fractures frequently present with nonunion and proximal pole necrosis, the treatment of which is bone grafting. Pronator quadratus pedicled vascularized bone graft is an option especially in the setting of proximal pole necrosis. We describe our experience of managing such scaphoid non-unions using pronator quadratus pedicled vascularized bone graft. Six patients were managed using pronator quadratus pedicled vascularized bone graft following scaphoid fracture nonunion with proximal pole necrosis. All patients had good fracture healing and symptom resolution. Mild deficit in wrist extension was noted in all patients. Pronator quadratus pedicled vascularized bone graft is an attractive option for managing scaphoid nonunion. Lying adjacent to the fracture site, bone can be harvested and transferred without making any other incisions. This procedure introduces another source of blood supply to the fracture site and hence improves fracture healing.

Rising incidence of scaphoid fracture surgery in Finland

2017 ◽  
Vol 43 (4) ◽  
pp. 402-406 ◽  
Author(s):  
Lauri T. Raittio ◽  
Jarkko Jokihaara ◽  
Tuomas T. Huttunen ◽  
Olli V. Leppänen ◽  
Antti P. Launonen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Scaphoid Fracture ◽  
Level Of Evidence ◽  
Scaphoid Fractures ◽  
Fixation Group ◽  
Fracture Nonunion ◽  
Rising Incidence ◽  
Fracture Surgery ◽  
Primary Fracture

The aim of the present study was to investigate the incidence of scaphoid fracture surgery by obtaining data from the national discharge register in Finland, a country of 5 million inhabitants, for the period from 1997 to 2014. A total of 1380 patients with scaphoid fracture were treated surgically. Half of the patients were aged under 28 years and 84% were men. The surgical treatment of scaphoid fractures was classified into two groups. There were 640 (46%) primary fracture fixations and 740 (54%) treatments of fracture nonunion. The overall incidence of all scaphoid fixations increased twofold (from 14.8 to 30.1 per 1,000,000 person-years) and threefold in the primary fixation group (from 5.5 to 17.8 per 1,000,000 person-years) during the study period. Level of evidence: III

scholarly journals Mandibular Reconstruction With Block Iliac Crest: An Institutional Experience

2020 ◽  
Vol 13 (4) ◽  
pp. 285-289
Author(s):  
Camila Camarini ◽  
Guilherme Spagnol ◽  
Manuela Monteiro Pinotti ◽  
Alan Motta do Canto ◽  
Fernando Alves Maciel ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Bone Graft ◽  
Surgical Approach ◽  
Iliac Crest ◽  
Mandibular Reconstruction ◽  
Autogenous Bone Graft ◽  
Autogenous Bone ◽  
Fisher Exact Test ◽  
Significance Level ◽  
Exact Test

Study Design: Mandibular reconstruction is a challenge. Several reconstructive techniques are available, and the individualization of choice for each patient leads to better results and quality of life for the individual. Objective: The aim of this study is to evaluate the characteristics and complications of cases submitted to mandibular reconstruction with autogenous bone graft block of the iliac crest. Methods: Records of 45 patients undergoing mandibular reconstruction with autogenous bone graft block of the iliac crest were analyzed from January 2000 to December 2014. The data collected included age, gender, etiology and graft size, surgical approach, complications, comorbidities, and habits and addictions. Analysis of variance, chi-square test, and Fisher exact test were used for analysis of the variables with a significance level of P < .05. Results: The success rate of the 45 charts analyzed was 75.6%. No statistical differences were found between age and presence of complications, between defect size and presence or absence of complications, and between type of surgical approach and presence or absence of complications. Conclusion: According to our study, medical history may influence postoperative complications and require attention, though further studies should be performed to further elucidate the relationship between diseases and postoperative complications.

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