scholarly journals Arthroscopic Bone Grafting and Kirschner-Wires Fixation for Scaphoid Nonunion

2020 ◽  
Vol 25 (2) ◽  
pp. 90-100
Author(s):  
Young Keun Lee ◽  
Mooheon Jeon ◽  
Ha Song Lee
Keyword(s):  
Minimally Invasive ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Surgical Techniques ◽  
Surgical Trauma ◽  
Percutaneous Fixation ◽  
Cancellous Bone Graft ◽  
Scaphoid Nonunion ◽  
Kirschner Wires ◽  
Vascularized Bone

Various surgical techniques, such as corticocancellous or cancellous bone graft and other vascularized bone grafting techniques have been developed to treat scaphoid nonunion. However, open grafting with dissection of wrist capsule and ligaments damages the joint and hence can lead to increased stiffness of the wrist and hand. Arthroscopic assisted bone grafting and percutaneous fixation have advantages such as minimal surgical trauma to the scaphoid blood supply and its ligament connection and provide a thorough wrist assessment, comprehensive approach for scaphoid nonunion and its sequelae in a minimally invasive manner. This article briefly discusses the characteristic anatomy of the wrist and scaphoid, and reviews the technique of arthroscopic bone grafting and percutaneous fixation for the treatment of scaphoid nonunion.

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.

The Repair and Healing of Two Traumatic Ilial Body Fractures Adjacent to Cemented Total Hip Acetabular Components

1992 ◽  
Vol 05 (02) ◽  
pp. 85-89
Author(s):  
P. K. Shires ◽  
T. L. Dew
Keyword(s):  
Internal Fixation ◽  
Cancellous Bone ◽  
Surgical Techniques ◽  
Autogenous Bone ◽  
Cancellous Bone Graft ◽  
Standard Methods ◽  
Intravenous Antibiotics ◽  
Prophylactic Use ◽  
Acetabular Components ◽  
Autogenous Bone Grafts

SummaryThis report has documented the repair and healing of two ilial fractures in dogs which were compounded by the presence of a cemented acetabular prosthesis. While specific recommendations can not be made from such a small number of cases, the information presented herein suggests that such fractures will heal without complication if aseptic surgical techniques and standard methods of internal fixation are employed. The authors strongly recommend the prophylactic use of intravenous antibiotics and the placement of cancellous bone graft when the repair of such fractures is attempted.Two traumatic ilial fractures involving the cement/bone interface of acetabular prostheses were repaired using lag screws, cerclage wires, and autogenous bone grafts. The fractures healed and ambulatory function was regained.

Addition to the Toolbox of Surgical Techniques for Palatal Fistula Repair

2021 ◽  
pp. 105566562110037
Author(s):  
Catherine de Blacam ◽  
David Orr
Keyword(s):  
Bone Graft ◽  
Cancellous Bone ◽  
Hard Palate ◽  
Surgical Techniques ◽  
Cancellous Bone Graft ◽  
Fistula Repair ◽  
Palatal Fistula

In response to the article by Rothermel and colleagues, the authors suggest the use of cancellous bone graft for repair of fistulae of the hard palate as an addition to the proposed toolbox.

TREATMENT OF SCAPHOID NONUNION USING VOLAR BICONCAVE CANCELLOUS BONE GRAFTING

Hand Surgery ◽  
2007 ◽  
Vol 12 (02) ◽  
pp. 135-140 ◽  
Author(s):  
M. Yasuda ◽  
Y. Ando ◽  
K. Masada
Keyword(s):  
Cancellous Bone ◽  
Bone Grafting ◽  
Bony Union ◽  
Scaphoid Nonunion ◽  
Radiographic Appearance ◽  
Cancellous Bone Grafting ◽  
Volar Approach ◽  
Pin Fixation ◽  
The Mean ◽  
Grafting From

We report the results of 28 patients with scaphoid nonunion treated with curettage and biconcave cancellous bone grafting from the distal radius using a volar approach and pin fixation. This study consisted of 28 patients (24 males and 4 females). The mean age at surgery was 28 years. The mean interval from injury to surgery was 22 months. The mean follow-up period was 20 months. By Russe classification, there were 6 distal third nonunions, 19 middle third nonunions and 3 proximal third nonunions. We reviewed final function and radiographic appearance. Bony union was achieved in all cases. Pins were removed at a mean of 7 weeks after surgery. Post-activity pain resolved in all cases. Mean wrist extension was 79° and mean flexion 77°. Mean grip strength was 35.8 kgf. The mean postoperative radio-lunate angle was 4.9° (-21–28.8) compared to -5.9° (-37.5–17.5) preoperatively. No complications were encountered. Our procedure is straightforward and not technically demanding. An STT arthrotomy is not necessary and the technique allows for concurrent correction of carpal instability. Bony union was achieved in all cases with no complications.

Mid-term outcome of volar plate fixation for scaphoid nonunion

2020 ◽  
Vol 102-B (12) ◽  
pp. 1697-1702
Author(s):  
Philip Marcel Jozef Schormans ◽  
Maria A. Kooijman ◽  
Jan A. Ten Bosch ◽  
Martijn Poeze ◽  
Pascal F. W. Hannemann
Keyword(s):  
Functional Outcome ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Locking Plate ◽  
Plate Fixation ◽  
Ct Scans ◽  
Scaphoid Nonunion ◽  
Cancellous Bone Grafting ◽  
The Mean

Aims Fixation of scaphoid nonunion with a volar locking plate and cancellous bone grafting has been shown to be a successful technique in small series. Few mid- or long-term follow-up studies have been reported. The aim of this study was to report the mid-term radiological and functional outcome of plate fixation for scaphoid nonunion. Methods Patients with a scaphoid nonunion were prospectively enrolled and treated with open reduction using a volar approach, debridement of the nonunion, and fixation using a locking plate and cancellous bone grafting, from the ipsilateral iliac crest. Follow-up included examination, functional assessment using the patient-rated wrist/hand evaluation (PRWHE), and multiplanar reformation CT scans at three-month intervals until union was confirmed. Results A total of 49 patients with a mean age of 31 years (16 to 74) and a mean duration of nonunion of 3.6 years (0.4 to 16) were included. Postoperatively, the nonunion healed in 47 patients (96%) as shown on CT scans. The mean time to union was 4.2 months (3 to 12). Due to impingement of the plate on the volar rim of the radius and functional limitation, the hardware was removed in 18 patients. At a median follow-up of 38 months in 34 patients, the mean active range of motion (ROM) improved significantly from 89° to 124° (SD 44°; p = 0.003). The mean grip strength improved significantly from 52% to 79% (SD 28%; p < 0.001) of the contralateral side. The mean PRWHE score improved significantly from 66 to 17 points (SD 25; p < 0.001). Conclusion Locking plate fixation supplemented with autologous cancellous bone grafting is a successful form of treatment for scaphoid nonunion. Functional outcomes improve with the passage of time, and mid-term results are excellent with a significant improvement in ROM, grip strength, and functional outcome as measured by the PRWHE. Cite this article: Bone Joint J 2020;102-B(12):1697–1702.

scholarly journals MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

2005 ◽  
Vol 34 (6) ◽  
pp. 314-320 ◽  
Author(s):  
Suzanne E. Anderson ◽  
Lynne S. Steinbach ◽  
Dechen Tschering-Vogel ◽  
Matthias Martin ◽  
Ladislav Nagy
Keyword(s):  
Mr Imaging ◽  
Bone Grafting ◽  
Scaphoid Nonunion ◽  
Before And After ◽  
Vascularized Bone

scholarly journals Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion

2017 ◽  
Vol 07 (01) ◽  
pp. 024-030 ◽  
Author(s):  
Peter Brink ◽  
Martijn Poeze ◽  
Pascal Hannemann ◽  
Philip Schormans
Keyword(s):  
Range Of Motion ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Scaphoid Nonunion ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Cancellous Bone Grafting ◽  
Scaphoid Fractures ◽  
Radiological Healing

Background Around 5 to 15% of all scaphoid fractures result in nonunion. Treatment of long-lasting scaphoid nonunion remains a challenge for the treating surgeon. Healing of scaphoid nonunion is essential for prevention of scaphoid nonunion advanced collapse and the subsequent predictable pattern of radiocarpal osteoarthritis. Purpose The purpose of this study was to investigate the feasibility of fixation of the scaphoid nonunion with a volar angular stable miniplate and cancellous bone grafting. We hypothesized that this technique could be successful, even in patients with previous surgery for nonunion and in patients with a long duration of nonunion. Patients and Methods A total of 21 patients enrolled in a single-center prospective cohort study. Healing of nonunion was assessed on multiplanar computed tomography scan of the wrist at a 3-month interval. Functional outcome was assessed by measuring grip strength, range of motion, and by means of the patient-rated wrist and hand evaluation (PRWHE) questionnaire. Results During follow-up, 19 out of 21 patients (90%) showed radiological healing of the nonunion. The range of motion did not improve significantly. Postoperative PRWHE scores decreased by 34 points. Healing occurred regardless of the length of time of the nonunion (range: 6–183 months) and regardless of previous surgery (38% of patients). Conclusion Volar angular stable miniplate fixation with autologous cancellous bone grafting is a successful technique for the treatment of chronic unstable scaphoid nonunion, even in patients with long-lasting nonunion and in patients who underwent previous surgery for a scaphoid fracture. Rotational interfragmentary stability might be an important determining factor for the successful treatment of unstable scaphoid nonunion. Level of Evidence Level IV.

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