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scaphoid non-union

Gernot Schmidle, Hannes Leonhard Ebner, Günter Klima, Kristian Pfaller, Josef Fritz, Romed Hoermann, Markus Gabl
The scaphoid is the most frequently fractured carpal bone and prone to non-union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal)...
February 27, 2018: Journal of Anatomy
Rebecca Woehl, Johannes Maier, Sebastian Gehmert, Christoph Palm, Birgit Riebschlaeger, Michael Nerlich, Michaela Huber
BACKROUND: Scaphoidectomy and midcarpal fusion can be performed using traditional fixation methods like K-wires, staples, screws or different dorsal (non)locking arthrodesis systems. The aim of this study is to test the Aptus four corner locking plate and to compare the clinical findings to the data revealed by CT scans and semi-automated segmentation. METHODS: This is a retrospective review of eleven patients suffering from scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist, who received a four corner fusion between August 2011 and July 2014...
February 13, 2018: BMC Musculoskeletal Disorders
Anil K Bhat, Ashwath M Acharya, S Manoh, Vinay Kamble
BACKGROUND: To identify acute un-displaced and minimally displaced scaphoid fractures which are unlikely to unite with non-operative treatment at six weeks with CT scan and stabilize them with percutaneous screw fixation with the aim of preventing non-union. METHODS: A scaphoid series radiographs of wrist were obtained for patients with undisplaced or minimally displaced fractures and were immobilized in a thumb spica cast for six weeks. At six weeks, CT scan was done for patients showing doubtful signs of clinical and radiographic union...
March 2018: Journal of Hand Surgery Asian-Pacific Volume
Samir Kumta, Sudhir Warrier, Leena Jain, Rani Ummal, Manik Menezes, Shrirang Purohit
Introduction: Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Amit Kumar, B P Sharma, Saurabh
Background: Scaphoid fracture is the most common among carpal bone fractures, frequently imperceptible on initial radiographs. Tendency of scaphoid fracture to undergo in non-union makes it an important challenging injury for all orthopaedic surgeons. Displaced scaphoid fracture has high non-union rate in conservative management asserting the need to explore operative treatment. Materials and method: A prospective study was conducted in our institution in thirty patients in 20 to 50 year age group, for displaced scaphoid fracture (<30 days duration)...
November 2017: Journal of Clinical Orthopaedics and Trauma
Kai Yuen Wong, Olivia Sharp, Phillip Johnston
Scaphoid non-union affects wrist joint function and is often associated with a predictable pattern of degenerative change. A 30-year-old man presented with a symptomatic 15-year-old right scaphoid fracture with secondary scaphoid non-union advanced collapse of his right wrist. There was no evidence of avascular necrosis. The initial injury was from a fall onto his outstretched hand. We performed a right scaphoid open reduction, internal fixation and iliac crest bone graft. One year after the operation, the patient had good wrist function and grip strength...
January 4, 2018: BMJ Case Reports
Thomas Meszaros, Esther Vögelin, Lukas Mathys, Franck Marie Leclère
BACKGROUND: Perilunate dislocations and fracture-dislocations are a subcategory of the carpal instability complex. Herein, we report our university hospital experience with this complex injury. The goal of our study was to find predictive factors and quantify the development of arthritis and lunate necrosis. We tried to measure the impact of arthritis on hand function. METHODS: Between January 2000 and December 2014, 21 patients underwent surgery for perilunate dislocations and perilunate fracture-dislocations of the wrist in our tertiary university center...
February 2018: Archives of Orthopaedic and Trauma Surgery
S S Dedeoğlu, Y İmren, H Çabuk, A C Tekin, Y C Türe, H Gürbüz
Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union...
February 2018: Hand Surgery and Rehabilitation
G Luengo Alonso, V Jiménez Díaz, L Garcia Lamas, M A Porras Moreno, D Cecilia López
OBJECTIVE: Herbert type B1 and B2 scaphoid fractures can be treated by orthopaedic treatment or surgery. The aim of this study is to analyse results and complications of scaphoid waist fractures treated using the percutaneous volar approach. MATERIAL AND METHOD: We present a retrospective study of 92 patients, treated in our institution from 2006 to 2016 using a volar percutaneous fixation. Mean Follow-up was 16 months (range 12-48). Injuries were classified using Hebert's classification, including B1 and B2 fracture types; the other fracture types following this classification system were excluded...
November 28, 2017: Revista Española de Cirugía Ortopédica y Traumatología
Timothy J Luchetti, Allison J Rao, John J Fernandez, Mark S Cohen, Robert W Wysocki
We present 20 patients with established proximal pole scaphoid nonunions treated with curettage and cancellous autograft from the distal radius and screw fixation. Fractures with significant proximal pole fragmentation were excluded. Patients were treated at a mean of 26 weeks after injury (range 12-72). Union occurred in 18 of 20 patients (90%) based on computed tomographic imaging. The two nonunions that did not heal were treated with repeat curettage and debridement and iliac crest bone grafting without revision of fixation...
January 1, 2017: Journal of Hand Surgery, European Volume
Ramin Mandegaran, Sam Gidwani, Ali Zavareh
OBJECTIVE: The scaphoid is the most commonly fractured carpal bone. The presence of a concomitant hook of hamate fracture is of particular relevance given that it is often occult on routine wrist/scaphoid radiographs and that hook of hamate fractures are prone to symptomatic non-union, resulting in chronic ulnar wrist pain. Prompt diagnosis and immobilisation/fixation may minimise such complications. Our study is aimed at assessing the frequency of concomitant hook of hamate fractures in patients with scaphoid fractures...
November 16, 2017: Skeletal Radiology
Gloria M Hohenberger, Uldis Berzins, Bore Bakota, Patrick Holweg, Bernhard Clement, Stephan Grechenig
BACKGROUND: Percutaneous scaphoid fixation through either a volar or dorsal approach has the advantage of minor soft tissue damage compared with ORIF, and faster fracture union compared with conservative treatment. However, this technique demands highly intraoperative reliance on X-ray control, including increased radiation exposure and all associated side effects. PURPOSE: To test the possibility and efficacy of volar percutaneous scaphoid screw placement under minimalradiation exposure...
November 2017: Injury
Christophe L Mathoulin, Margareta Arianni
Treatment of scaphoid fractures has been focused mainly on achieving union, with less attention to restoring normal scaphoid shape and orientation. Malalignment of one carpal bone will disrupt the kinetics of the entire wrist. The dorsal intercalated segment instability deformity associated with scaphoid waist nonunion is a nondissociative form of carpal instability. It has to be reduced in the treatment of scaphoid waist nonunions to avoid kinetic problems that will lead to arthritic changes. Computerized tomography scanning has become indispensable to visualize the humpback deformity clearly...
January 2018: Journal of Hand Surgery, European Volume
Mark Henry
The reported results for the treatment of scaphoid nonunions with non-vascularized grafts are based on observational studies with a high variability in union rates from 38%-100% and time to union from 6-18 weeks, and there is also a lack of a standard classification. Meta-analyses and systematic reviews have been presented to better support conclusions from large pools of data (604 to 5246 cases), but their interpretation remains limited because of lack of uniformity in the studies analysed. Several authors have presented results from the Zaidemburg flap, with highly variable outcomes despite using the same technique; union rates have ranged from 27%-100% achieved between 6...
January 1, 2017: Journal of Hand Surgery, European Volume
Jihyeung Kim, Jin Woo Park, Jeehyeok Chung, Kee Jeong Bae, Hyun Sik Gong, Goo Hyun Baek
We present the surgical outcomes of non-vascularized bone grafting taken from the iliac crest in 24 patients with scaphoid nonunion and avascular necrosis. The Fisk-Fernandez technique was used in 11 patients, and cancellous bone grafting was used in 13 patients. Bony union was achieved in 22 of the 24 patients. Non-vascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. Although revascularization of the proximal fragment after surgery was not evaluated, bony union was confirmed in nearly all patients...
January 1, 2017: Journal of Hand Surgery, European Volume
Manish Kiran, Ian Persaud, Arpit Jariwala, Carlos Wigderowitz
BACKGROUND: Scaphoid non-union is often caused due to missed fractures, inadequate or inappropriate management. Matti-Russe and interpositional grafting techniques are used in the treatment of non-union. There are very few studies in literature that compare the outcomes of these techniques. The aim of our study was to analyse the factors influencing outcome in the management of scaphoid non-union and to compare the results of the Matti Russe procedure with interpositional grafting techniques...
September 2017: Journal of Hand Surgery Asian-Pacific Volume
P J Delgado-Serrano, I Jiménez-Jiménez, M Nikolaev, F A Figueredo-Ojeda, M Gil de Rozas-López
OBJECTIVE: To evaluate the results of arthroscopic reconstruction for the treatment of unstable scaphoid non-union with cancellous bone autograft. METHODS: 13 patients were treated with a mean age of 26 (18-45) years. The average time from injury until surgery was 14 (6-48) months. Preoperative and postoperative clinical and radiological parameters were evaluated. Mean follow-up was 16.8 (12-36) months. RESULTS: Consolidation was achieved in all cases at 7 (4-10 weeks), no patient had complications or reoperations...
May 1, 2017: Revista Española de Cirugía Ortopédica y Traumatología
Alexis Pereira, Juan José Hidalgo Díaz, Maurise Saur, Santiago Salazar Botero, Sybille Facca, Philippe Liverneaux
BACKGROUND: The purpose of this retrospective comparative study was to assess whether a complementary treatment by pulsed electromagnetic field could increase the bone-healing rate of scaphoid non-union without SNAC (scaphoid non-union advanced collapse) treated by retrograde percutaneous screw fixation. CASE DESCRIPTION: Eighteen patients with scaphoid non-union were included in this retrospective study. The group 1 was made of nine cases (seven stage IIA and two stage IIB) of scaphoid non-union treated by retrograde percutaneous screw fixation and pulsed electromagnetic fields (Physiostim(®))...
May 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Edward W Seger, Julio J Jauregui, Steven A Horton, Gerardo Davalos, Erika Kuehn, Michael A Stracher
BACKGROUND: Scaphoid fractures progress to nonunion rates of up to 15% when non-displaced, and are even more frequent when the fracture is displaced. Standard treatment in these cases is surgery; however, individuals unable to undergo this operation, or for those who wish to try more conservative measures, there may be benefit from nonoperative options. Of these, low-intensity pulsed ultrasound (LIPUS) has been shown to improve fracture nonunion healing. The purpose of this study was to perform a comprehensive meta-analysis of relevant literature to determine success of the use of LIPUS for treatment of scaphoid nonunion...
April 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
Moritz Dustmann, Ralf Bajinski, Alexander Tripp, Joachim Gülke, Nikolaus Wachter
INTRODUCTION: In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated...
June 2017: Archives of Orthopaedic and Trauma Surgery
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