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 Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Chen-Wei Yeh ◽  
Cheng-En Hsu ◽  
Wei-Chih Wang ◽  
Yung-Cheng Chiu
Keyword(s):  
Grip Strength ◽  
Bone Grafting ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Radiographic Outcomes ◽  
Mayo Wrist Score ◽  
Function Recovery ◽  
Prolonged Recovery ◽  
Preoperative Status ◽  
Mean Time

Abstract Background Surgical treatment is necessary for scaphoid nonunion. Open surgery with a combined volar and dorsal approach is thought to have poor functional outcomes and a prolonged recovery course. However, the detailed recovery course for this approach is rarely reported. The aim of this study was to investigate the recovery course and radiographic outcome for patients with scaphoid nonunion who underwent a combined volar bone grafting and dorsal antegrade headless screw approach. Material and methods Eighteen patients with scaphoid nonunion who underwent combined volar bone grafting and dorsal antegrade headless screw fixation were enrolled in this retrospective study. Preoperative and serial postoperative wrist functional and radiographic outcomes were collected and analysed. Results All 18 patients achieved bone union at a mean time of 14.3 weeks. Compared to the preoperative status, the grip strength, wrist motion arc, and Mayo Wrist score were improved significantly 6 months after surgery, whilst the Disabilities of the Arm, Shoulder, and Hand (DASH) score did not recover until 12 months after surgery. Significant improvements were found in all scaphoid radiographic parameters. Conclusion The surgical outcomes for scaphoid nonunion treated with a combined volar bone grafting and dorsal antegrade headless screw achieved a high union rate, with great wrist functional and radiographic outcomes. The earliest recovered wrist functional parameters were grip strength, motion arc, Mayo Wrist score and finally the DASH score at postoperative 6 months and 12 months, respectively.

scholarly journals Wrist Function Recovery Course in Patients with Scaphoid Nonunion Treated with Combined Volar Bone Grafting and a Dorsal Antegrade Headless Screw

2020 ◽  
Author(s):  
Chen-Wei Yeh ◽  
Cheng-En Hsu ◽  
Wei-Chih Wang ◽  
Yung-Cheng Chiu
Keyword(s):  
Grip Strength ◽  
Bone Grafting ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Radiographic Outcomes ◽  
Mayo Wrist Score ◽  
Function Recovery ◽  
Prolonged Recovery ◽  
Preoperative Status ◽  
Mean Time

Abstract Objectives:Surgical treatment is necessary for scaphoid nonunion. Open surgery with a combined volar and dorsal approach is thought to have poor functional outcomes and a prolonged recovery course. However, the detailed recovery course for this approach is rarely reported. The aim of this study was to investigate the recovery course and radiographic outcome for patients with scaphoid nonunion who underwent a combined volar bone grafting and dorsal antegrade headless screw approach.Material and methods:Eighteen patients with scaphoid nonunion who underwent combined volar bone grafting and dorsal antegrade headless screw fixation were enrolled in this retrospective study. Preoperative and serial postoperative wrist functional and radiographic outcomes were collected and analysed.Results:All 18 patients achieved bone union at a mean time of 14 weeks. Compared to the preoperative status, the grip strength was significantly recovered, and the Mayo wrist score improved significantly 6 months after surgery. Wrist motion arc was significantly improved 9 months after surgery, while the Disabilities of the Arm, Shoulder, and Hand (DASH) score did not recover until 12 months after surgery. Significant improvements were found in all scaphoid radiographic parameters.Conclusion:The surgical outcomes for scaphoid nonunion treated with a combined volar bone grafting and dorsal antegrade headless screw achieved a high union rate, with great wrist functional and radiographic outcomes. The earliest recovered wrist functional parameters were grip strength and Mayo wrist score followed by the motion arc and finally the DASH score at postoperative 6, 9 months and 12 months, respectively.

Percutaneous Screw Fixation for Acute Scaphoid Fractures Through K-wire-assisted Reduction and Maintenance

2020 ◽  
Author(s):  
Jiangbo Bai ◽  
Lingde Kong ◽  
Siyu Tian ◽  
Kunlun Yu ◽  
Jian Lu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Screw Fixation ◽  
Operation Time ◽  
Fixation Method ◽  
Bony Union ◽  
Wrist Flexion ◽  
Percutaneous Screw Fixation ◽  
Scaphoid Fractures ◽  
Early Return

Abstract Background: Percutaneous screw fixation was introduced for acute scaphoid fractures through K-wire-assisted reduction and maintenance, and the effectiveness of the methods was evaluated.Methods: Ten patients with acute scaphoid fractures were consecutively treated with the proposed technique from January 2015 to December 2018. With the wrist placed in ulnar deviation, one K-wire was introduced perpendicularly through the styloid process of radius into the proximal pole of scaphoid under fluoroscopic guidance. The scaphoid fragment was reduced by dorsiflexing the wrist and translating the distal pole into an extended position. A headless compression screw was then inserted in a standardised manner. Operation time, time to union, time to return to previous activity and complication were recorded. Function outcomes including pain, work status, range of motion (ROM) and grip strength were assessed according to the modified Mayo wrist scoring system.Results: Final follow-up examination was performed on an average of 12 months (range, 10–15 months) after surgery. No immediate postoperative complication occurred. All scaphoid fractures united at an average of 9.2 weeks (range, 7–11.4 weeks). The following average values were achieved: operation time was 48.2 minutes (range, 38–65 minutes), the time that patients returned to previous activity levels was 9.4 weeks (range, 7–11 weeks) and function scores were 92.5 (range, 80–100). At 3 months post-operation, the wrist range of motion was generally 62.5° wrist extension (range, 50°–70°) and 68.2° wrist flexion (range, 55°–75°). Grip strength was approximately 40.1 kg (range, 28–45 kg) and 83.5% (range, 85%–100%) of the contralateral sides. The mean post-operative height-to-length ratio was 0.61.Conclusions: Our novel percutaneous screw fixation method is beneficial to minimise injury to the blood supply of the scaphoid. Primary percutaneous screw fixation for acute scaphoid fractures is a superior method with reduced time to bony union, early return to daily activity or employment and predictably lessened complications of wrist stiffness, diminished grip strength, delayed union, non-union and osteonecrosis.Trial registration: Clinicaltrials.gov; NCT04482868; Registered 19 July 2020-Retrospectively registered.

THE MODIFIED BRUNELLI PROCEDURE FOR SCAPHOLUNATE INSTABILITY: A SINGLE CENTRE STUDY

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 39-42 ◽  
Author(s):  
Prasad Ellanti ◽  
Gurudattsingh Sisodia ◽  
Abdulla AL-Ajami ◽  
Priyanka Ellanti ◽  
Paul Harrington
Keyword(s):  
Soft Tissue ◽  
Grip Strength ◽  
Ligament Reconstruction ◽  
Tendon Graft ◽  
Dash Score ◽  
Wrist Flexion ◽  
Single Centre ◽  
Scapholunate Instability ◽  
Single Centre Study ◽  
Preoperative Score

Management of scapholunate (SL) instability remains controversial. The modified Brunelli procedure is a soft tissue procedure that recreates the stabilising forces of the SL ligament using a split flexor carpi radialis tendon graft passed from volar to dorsal via a tunnel in the distal pole of the scaphoid. Thirteen consecutive patients with an average age of 35 years underwent the modified Brunelli procedure. Pain improved from a mean visual analog score of eight preoperatively to 1.5. The DASH score improved from a preoperative score of 55.4 to 34.9 as did the grip strength from 40% to 75% respectively. All wrist ranges of motion were decreased post-operatively in particular wrist flexion. SL ligament reconstruction using the modified Brunelli procedure resulted in satisfactory outcomes. Post-operatively patients were relatively pain free, with improved grip strength. The range of motion was reduced postoperatively, however did not restrict return to work or premorbid activities.

scholarly journals Analysis of functional outcome of complex forearm injuries

2017 ◽  
Vol 3 (5) ◽  
pp. 904
Author(s):  
Saranjeet Singh Jagdev ◽  
Subodh Kumar Pathak ◽  
Abhijeet Salunke ◽  
Pritam Maheshwari ◽  
Prahlad Ughareja
Keyword(s):  
Grip Strength ◽  
Bone Grafting ◽  
Care Center ◽  
Tertiary Care ◽  
Skin Grafting ◽  
Pinch Strength ◽  
Dash Score ◽  
Superficial Infection ◽  
Forearm Injuries

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective non-union, stiffness, disabilities and secondary amputations.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final follow-up. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.</span></p>

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.

Is revision bone grafting worthwhile after failed surgery for scaphoid nonunion? Minimum 8 year follow-up of 18 patients

2009 ◽  
Vol 34 (6) ◽  
pp. 772-777 ◽  
Author(s):  
O. REIGSTAD ◽  
R. THORKILDSEN ◽  
C. GRIMSGAARD ◽  
A. REIGSTAD ◽  
M. RØKKUM
Keyword(s):  
Bone Grafting ◽  
Scaphoid Nonunion ◽  
Wrist Flexion ◽  
Revision Procedure ◽  
Visual Analogue Pain ◽  
Flexion Extension ◽  
Failed Surgery ◽  
The Mean ◽  
Observation Period

Eighteen patients who underwent revision non-vascularized bone grafting and internal fixation after failed surgery for scaphoid nonunion were reviewed after a minimum of 8.2 years. Eleven of the nonunions were located in the middle and seven in the proximal third of the scaphoid. The mean interval between injury and the revision procedure was 6 years. Sixteen of the 18 nonunions healed, two after a third attempt. Three patients with healed nonunions and one patient with persistent nonunion required salvage procedures for progressive radiocarpal arthrosis. In the remaining 14 cases, the mean loss of wrist flexion/extension arc compared to the contralateral wrist was 36 °. Mean reduction of grip strength and key pinch was 9.3 kg and 0.9 kg respectively. The QuickDASH score was 18 and a visual analogue pain score was 21/100 at follow-up. Wrist degeneration increased in all but one case during the observation period. Thirteen of 16 patients with union and one patient with a persisting nonunion experienced moderate symptoms.

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