Can headless screw used in fixation of the scaphoid proximal pole fracture be broken after wrist trauma? An unreported complication of scaphoid surgery

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.

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DORSAL OPEN REPAIR OF PROXIMAL POLE SCAPHOID FRACTURES

Hand Clinics ◽

10.1016/s0749-0712(21)01444-x ◽

2001 ◽

Vol 17 (4) ◽

pp. 601-610

Author(s):

Keith B. Raskin ◽

Debra Parisi ◽

Janet Baker ◽

Michael E. Rettig

Keyword(s):

Open Repair ◽

Proximal Pole ◽

Scaphoid Fractures

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Prosthetic Replacement of the Scaphoid Proximal Pole: Should It Be the Future?

Hand ◽

10.1177/1558944720974120 ◽

2020 ◽

pp. 155894472097412

Author(s):

Matteo Ferrero ◽

Enrico Carità ◽

Francesco Giacalone ◽

Julien Teodori ◽

Alberto Donadelli ◽

...

Keyword(s):

Avascular Necrosis ◽

Early Mobilization ◽

Functional Results ◽

Good Alternative ◽

Proximal Row Carpectomy ◽

Proximal Pole ◽

Subjective Outcomes ◽

Clinical Worsening ◽

Pyrocarbon Implant ◽

Over Time

Background Scaphoid proximal pole fractures with avascular necrosis represent a complex surgical problem. Many reconstruction techniques are based on osteosynthesis with a vascularized or nonvascularized bone graft. These procedures do not allow early mobilization and therefore sometimes lead to unsatisfying functional results. In some cases, it is possible to perform a scaphoid hemiarthroplasty using a pyrocarbon implant (adaptive proximal scaphoid implant [APSI]) in place of the necrotic proximal pole, allowing an early mobilization and delaying palliative treatments such as 4-corner arthrodesis or proximal row carpectomy. Methods In this study, we reviewed all patients who had undergone a scaphoid hemiarthroplasty using APSI in our institutions from 1999 to 2017; the F.U. was performed through radiographic, clinical, and subjective (Disabilities of the Arm, Shoulder, and Hand) analysis. Results The performances of scaphoid proximal pole implants are encouraging; radiographic, clinical, and subjective outcomes were good, and the functional recovery proved to be fast and reliable over time. Conclusions This study reports our experience in the use of APSI implants, which proved to be a good alternative to traditional techniques for treating avascular necrosis of the proximal pole, still allowing further surgical steps in case of clinical worsening over time (wrist osteoarthritis). These patients are usually young and present high functional demands. Our experience is promising, but we believe that further evaluation over time will be needed.

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Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Journal of Wrist Surgery ◽

10.1055/s-0040-1701512 ◽

2020 ◽

Vol 09 (03) ◽

pp. 203-208

Author(s):

Kristin E. Shoji ◽

F. Joseph Simeone ◽

Sezai Ozkan ◽

Chaitanya S. Mudgal

Keyword(s):

Bone Graft ◽

Common Mechanism ◽

Study Cohort ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Local Bone ◽

Case Series Study ◽

Increased Risk ◽

Surgical Fixation ◽

The Mean

Abstract Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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The development of the male gametophyte and spermatogenesis in Taxus baccata L

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1986.0042 ◽

1986 ◽

Vol 228 (1250) ◽

pp. 85-96 ◽

Cited By ~ 7

Keyword(s):

Pollen Tube ◽

De Novo ◽

Male Gametophyte ◽

Generative Cell ◽

Equal Size ◽

Taxus Baccata ◽

Transverse Wall ◽

Proximal Pole ◽

Spermatogenous Cell ◽

Tube Cell

The development of the male gametophyte of Taxus baccata has been studied over a period of 20 weeks, from germination of the microspore in February to spermatogenesis in July. A few days after germination the microspore nucleus divides and a transverse wall forms at the equator cutting off the small generative cell and a large tube cell. The latter immediately begins to expand to form the pollen tube. The first division thus establishes the polarity of the gametophyte and the generative cell is regarded as proximal. The transverse wall is ephemeral, and within six weeks it has disappeared. The nucleus of the generative cell divides while still at the proximal pole. The two daughter nuclei are unequal in size, but they remain associated and together move distally. The larger nucleus eventually becomes the nucleus of the spermatogenous cell, and the smaller the sterile nucleus. The spermatogenous cell acquires a distinctive cytoplasm and becomes surrounded by a wall which arises de novo . The nucleus of the spermatogenous cell enlarges, but always remains towards one side of the cell so that at mitosis the spindle is contained within one hemisphere. After division the wall of the spermatogenous cell is ruptured and the two sperms are released as naked nuclei of equal size. The cytoplasm of the spermatogenous cell degenerates as it enters the tube, but remains recognizable until fertilization.

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