A meta-analysis of union rate after proximal scaphoid fractures: terminology matters

Chong, Han Hong; Kulkarni, Kunal; Shah, Rohi; Hau, Melinda Y T; Athanatos, Lambros; Singh, Harvinder

doi:10.1080/2000656x.2021.1979016

Cited by 6 publications

(4 citation statements)

References 52 publications

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“…19 A concern regarding the published literature on proximal scaphoid fractures is the heterogeneity in the definition of 'proximal' and 'proximal pole'. 1,32,38 In a meta-analysis, Eastley et al 1 highlighted the consistent failure to define anatomical landmarks in the majority of published articles, which may have led to an inflated proportion of proximal pole fractures in several larger series. 22,39 A systematic review similarly described finding variability in methods for identifying and assessing proximal pole fractures, which made them difficult to analyze in any great detail.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopic bone graft and fixation for proximal scaphoid nonunions

Zhang

Liu

2022

The Bone & Joint Journal

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Aims This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation. Methods This was a retrospective analysis of 20 patients. All cases were delayed presentations (n = 15) or failed nonoperatively managed scaphoid fractures (n = 5). Surgery was performed at a mean duration of 27 months (7 to 120) following injury with arthroscopic debridement and arthroscopic iliac crest autograft. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 12 wrists, a headless screw in six, and a combination of a headless screw and single K-wire in two. Clinical outcomes were assessed using grip strength, patient-reported outcome measures, and wrist range of motion (ROM) measurements. Results Intraoperatively, established avascular necrosis of the proximal fragment was identified in ten scaphoids. All fractures united within 16 weeks, confirmed by CT. At a mean follow-up of 31 months (12 to 64), there were significant improvements in the Patient-Rated Wrist Evaluation, Mayo Wrist Score, abbreviated Disabilities of the Arm, Shoulder and Hand score, wrist ROM, grip strength, and the patients’ subjective pain score. No peri- or postoperative complications were encountered. Conclusion Our data indicate that arthroscopic bone grafting and fixation with cancellous autograft is a viable method in the treatment of proximal third scaphoid nonunions, regardless of the vascularity of the proximal fragment. Cite this article: Bone Joint J 2022;104-B(8):946–952.

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Section: Discussionmentioning

confidence: 99%

“…Proximal scaphoid fractures are less common than those of the waist, 1 but have a 2.4- to 7.5-times greater relative risk of nonunion when managed nonoperatively compared to more distal scaphoid fractures. 1,32 Such nonunions remain a formidable challenge. When left untreated, scaphoid nonunions can develop progressive degenerative changes.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic bone graft and fixation for proximal scaphoid nonunions

Zhang

Liu

2022

The Bone & Joint Journal

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“…51 As suggested by Chong et al, inconsistencies in studies describing the location of the fracture may underlie many of these heterogenous outcomes with union. 52…”

Section: Results Of Literature Review and Fracture Scenariosmentioning

confidence: 99%

“…51 As suggested by Chong et al, inconsistencies in studies describing the location of the fracture may underlie many of these heterogenous outcomes with union. 52 Before treating a scaphoid fracture proximal pole nonunion (PPNU), it is important to determine if AVN is present. Lim et al evaluated distal radius VBG for small proximal pole fragments (mean size 21% of the scaphoid) with AVN and achieved an 86% union rate with an MTU of 14 weeks.…”

Section: Proximal Pole Scaphoid Fracturesmentioning

confidence: 99%

Surgical Treatment of Scaphoid Fractures: Recommendations for Management

Samade,

Awan

2024

J Wrist Surg

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Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV

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