Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss

2011 ◽  
Vol 93-B (7) ◽  
pp. 932-936 ◽  
Author(s):  
M. Mahmoud ◽  
W. Koptan
Keyword(s):  
Bone Loss ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Scaphoid Nonunion ◽  
Percutaneous Screw Fixation

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.

Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting

2019 ◽  
Vol 44 (6) ◽  
pp. 594-599 ◽  
Author(s):  
Bo Liu ◽  
Feiran Wu ◽  
Chye Yew Ng
Keyword(s):  
Bone Grafting ◽  
Screw Fixation ◽  
Wrist Arthroscopy ◽  
Scaphoid Bone ◽  
Percutaneous Screw Fixation ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
The Mean ◽  
Dorsal Intercalated Segment Instability

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. All fractures united. At a mean follow-up of 21 months (range 12–48), the mean Mayo wrist score was 96, and patient-rated wrist evaluation was 4, and the flexion–extension arc was 90% of the contralateral wrist. We conclude that arthroscopy is valuable in the treatment of scaphoid delayed or nonunions and in judging the need for bone grafting. Our data indicate that regardless of cystic formation in the scaphoid, bone grafting is not always necessary. Percutaneous fixation alone is sufficient when scaphoid delayed or nonunions are between 8 weeks and 1 year following injury, without scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and when forceful probing confirms stability of the scaphoid arthroscopically. Level of evidence: IV

scholarly journals Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone

2019 ◽  
Vol 09 (01) ◽  
pp. 013-018 ◽  
Author(s):  
Robert Gvozdenovic ◽  
Rasmus Wejnold Joergensen ◽  
Stig Joerring ◽  
Claus Hjort Jensen
Keyword(s):  
Minimally Invasive ◽  
Distal Radius ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Treated Group ◽  
P Value ◽  
Percutaneous Screw Fixation ◽  
Level Of Evidence ◽  
Local Bone ◽  
Arthroscopically Assisted

Purpose Minimally invasive techniques have been recommended in the treatment of painful but stable scaphoid nonunions. The purpose of this study was to determine if arthroscopically assisted bone grafting provided superior results in healing as compared to percutaneous screw fixation. Materials and Methods One hundred sixty-four consecutive patients with scaphoid nonunions were retrospectively analyzed. One hundred forty-eight patients were treated with the open grafting techniques either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n = 8), the time from injury to surgery was 2.5 months (range: 2–4 months) and it was 27.3 months (range: 3–180 months) in the arthroscopic group (n = 8). The mean age was 39 years (range: 20–66) in the percutaneous group and 22 years (range: 16–32) in the arthroscopic group. In all cases, the Mini Acutrak headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks, mean 7 months (range: 3–12 months). Data were calculated with two-tailed Mann–Whitney U test based on p-value of < 0.05 that was considered statistically significant. Results We recorded no complications in any of the groups. Patients treated arthroscopically received cancellous bone grafting from the distal radius and all patients but one healed at a median of 7.8 weeks (range: 5–18 weeks). Seven patients in the percutaneous group healed at a mean of 10.5 weeks (range: 7–24 weeks), thus leaving one patient from each group without achieving union. Mann–Whitney U test showed the U value of 11, the critical value of U to be 13 (p < 0.05), thus significantly faster healing was observed in the arthroscopically treated group. Conclusions Arthroscopically treated patients achieved faster healing despite shorter time to surgery in the percutaneous group. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. Level of Evidence This is a Level III comparative study.

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.

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