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.

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 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 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>

Arthrodesis of the Wrist for Osteoarthritis: Outcome with a Minimum Follow-up of 4 Years

2003 ◽  
Vol 28 (6) ◽  
pp. 575-577 ◽  
Author(s):  
L. DE SMET ◽  
J. TRUYEN
Keyword(s):  
Pain Relief ◽  
Grip Strength ◽  
Contralateral Side ◽  
Dash Score ◽  
Wrist Arthrodesis ◽  
Additional Surgery ◽  
The Mean ◽  
Mean Time ◽  
Manual Activity

The outcome of total wrist arthrodesis was reviewed in 36 patients with osteoarthritis after a minimum follow-up of 4 years. Pain relief was not complete, and although 20 were pain free at rest, only six were pain-free during manual activity. Grip strength was 63% of the contralateral side and the DASH score remained high. Only 21 of the 34 could be re-employed. The mean time off work was 14 months. Complications were numerous and additional surgery was required in 21 patients.

scholarly journals Vascularized Bone Grafting for Scaphoid Nonunion with Humpback Deformity: The Surgical Technique

2020 ◽  
Vol 9 (06) ◽  
pp. 528-534
Author(s):  
Keikichi Kawasaki ◽  
Tetsuya Nemoto ◽  
Kazutoshi Kubo ◽  
Kazunari Tomita ◽  
Katsunori Inagaki
Keyword(s):  
Bone Grafting ◽  
Lateral Approach ◽  
Dorsal Side ◽  
Bony Union ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Bone Segment ◽  
The Mean ◽  
Dorsal Intercalated Segment Instability ◽  
Vascularized Bone

Abstract Background Scaphoid nonunion with humpback deformity and avascular necrosis (AVN) is a challenging problem. Correction of dorsal intercalated segment instability (DISI) requires grafting of a large and hard vascularized bone segment onto the volar side of the scaphoid. Purposes We have been treating the patients with one-incision vascularized bone grafting technique for scaphoid nonunion to improve blood supply and correct humpback deformity. We evaluated these cases retrospectively to the surgical efficacy of our procedure. Methods We harvested vascularized bone from the dorsal side of the radius using the method by Zaidemberg et al and inserted the cortical aspect into the scaphoid volar side using a direct lateral approach. Totally, 11 patients (nine males andtwo females) with a mean age of 40 years were recruited for this study. The mean time from fracture to treatment was 6 years and 3 months. The mean preoperative radiolunate angle was 25 degrees. All the patients showed AVN of the proximal scaphoid on T1-weighted images. An averaged follow-up period was 2 years and 3 months. Results Postoperative computed tomography revealed bony union in 10 patients (91% of union rate) with a mean modified Mayo'swrist score of 88 points (range, 75–100 points) and a mean disabilities of arm, shoulder, and hand (DASH) score of 4 points (range, 0–20 points). The mean radiolunate angle was corrected from 25 to 5 degrees. No adverse events were observed, except temporary mild paresthesia of the radial nerve territory in two patients. Conclusion This technique effectively corrected DISI in patients with scaphoid nonunion accompanied by humpback deformity and AVN.

scholarly journals Lateral approach for scaphoid excision and capitolunate arthrodesis in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists

2021 ◽  
Author(s):  
Hui-Kuang Huang ◽  
Yi-Chao Huang ◽  
Chin-Hsien Wu ◽  
Cheng-Yu Yin ◽  
Jung-Pan Wang
Keyword(s):  
Lateral Approach ◽  
Scaphoid Nonunion ◽  
Height Ratio ◽  
Radiographic Outcomes ◽  
Mayo Wrist Score ◽  
Straightforward Method ◽  
Flexion Extension ◽  
The Mean ◽  
Carpal Height

Abstract Background Four-corner arthrodesis (4-CA) is an effective treatment for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). Capitolunate arthrodesis is an alternative option that limits intercarpal fusion. We propose a lateral approach using a small incision over the scaphoid anatomic snuffbox, which could be a straightforward method for performing scaphoid excision and capitolunate arthrodesis. This approach would be beneficial for shortening the operative time, facilitating bone healing, and improving wrist motion. Methods Between 2016 and 2020, eight patients were enrolled retrospectively and underwent the lateral approach for scaphoid excision and capitolunate arthrodesis. We presented the radiographic outcomes, including fusion status, capitolunate angle, and carpal height ratio. The functional outcomes of wrist range of motion, grip strength, pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and Mayo wrist score were evaluated. Results Fusion could be achieved, without complications, in all eight patients, and the mean follow-up period was 22.4 months (12–38 months). Five operations were completed within 1 h and 30 min. Postoperatively, the mean capitolunate angle and carpal height ratio improved from 19.6o to 2.4o and 0.44–0.51%, respectively. At the final follow-up, the average flexion-extension arc was 76.3o, visual analogue scale for pain was 0.9, QuickDASH score was 26.4, and Mayo wrist score was 72.5. Conclusions The lateral approach for scaphoid excision and capitoluante arthrodesis in treating SLAC and SNAC could have several advantages, including easy performance since it is similar to the open method and the lack of need for dorsal wrist opening and closure, which may preserve surrounding circulation, avoid the formation of a dorsal scar, and mimic the advantages of arthroscopic treatment.

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

scholarly journals Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiao-Lei Fan ◽  
Jian Wang ◽  
De-Hua Zhang ◽  
Feng Mao ◽  
Yi Liao ◽  
...  
Keyword(s):  
Grip Strength ◽  
Skeletal Maturity ◽  
Kirschner Wire ◽  
Intramedullary Fixation ◽  
Dash Score ◽  
Reliable Technique ◽  
Dorsal Angulation ◽  
Neck Fracture ◽  
The Mean ◽  
The Impact

Abstract Background Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. Methods In this retrospective study, 21 children (aged 11–16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Results All patients were followed up for 12–24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2–4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0–4), the mean VAS was 0.19 ± 0.60 (range, 0–2), and the mean grip strength was 91.55 %±4.52 % (range, 85–101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. Conclusions Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. Level of evidence Level IV.

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