Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

Wang, Jung‐Pan; Huang, Hui‐Kuang; Shih, Jui-Tien

doi:10.1186/s12891-020-03850-w

Cited by 10 publications

(9 citation statements)

References 34 publications

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“…Some studies included patients with stage I SNAC [ 15 , 18 , 19 , 21 ] and radio-carpal or midcarpal osteoarthritis [ 21 ], with imaging suggestive of avascular necrosis [ 21 ]. One author [ 19 ] considered nonunion to be a permanent fracture at 3 months instead of 6 and described revision surgery, SNAC grade II, and avascular necrosis of the proximal pole.…”

Section: Resultsmentioning

confidence: 99%

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Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review

Rinaldi,

Pilla,

Chiaramonte

et al. 2024

Musculoskelet Surg

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The purpose of the study was to investigate whether arthroscopic treatment of carpal scaphoid nonunions by osteosynthesis with bone grafting represents a successful surgical technique. This systematic literature review, conducted following the PRISMA guidelines, explores the past 10 years of clinical studies concerning the arthroscopic treatment of scaphoid nonunions. The most relevant keywords were used to search the databases, and the Downs and Black 27-item checklist has been used as quality assessment tool. Twelve papers that meet the premised eligibility criteria have been identified. These studies demonstrate the efficacy of this surgical solution, achieving a postoperative union rate of 96% in the average time of 13.5 weeks. Regardless of the method of synthesis and the origin of the graft used, excellent results were obtained. Patients who underwent this procedure reported a pain reduction of almost 80% compared to the preoperative level, improvement in grip strength close to 40%, and recovery in wrist function during daily activities. Arthroscopy has numerous advantages compared to the open approach. These are technically recognized by the surgeon and by the patient. Some disadvantages include a longer intraoperative time and considerable significant technical difficulty. Arthroscopic treatment of scaphoid nonunion by osteosynthesis with bone graft achieves a 96% union rate of the treated scaphoid with satisfying clinical results.

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Section: Resultsmentioning

confidence: 99%

“…The medium time for achieving this result took 13.5 weeks (range 8–20 weeks, IQR 5.3 SD 3.5). Some authors have performed additional radiological measurements [ 15 , 18 , 22 , 25 ]. The most used radiological parameters were SLA (scapholunate angle) and RLA (radiolunate angle).…”

Section: Resultsmentioning

confidence: 99%

Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review

Rinaldi,

Pilla,

Chiaramonte

et al. 2024

Musculoskelet Surg

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“…2 Universitätsklinikum St. Pölten, Matthias-Corvinus Straße 45, 3100 St. Pölten, Austria. 3 Unternehmung Wiener Gesundheitsverbund Klinik Ottakring, Montleartstraße 37, 1160 Wien, Austria. 4 Lehrkrankenhaus Wiener Neustadt, Erwin-Schrödinger-Straße 4, 2700 Wiener Neustadt, Austria.…”

Section: Fundingunclassified

“…The necessity of metallic screw removal is under debate [ 2 ]. Wang et al [ 3 ] described that 89% of patients insisted on screw removal because of their cultural belief. Others report that screw removal was required owing to pain at the scaphotrapezial joint [ 4 ], and removal rates of 8–14% have been reported [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Sailer¹,

Lechner²,

Floßmann

et al. 2023

J Orthop Traumatol

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Background Allograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union. Patients and methods We retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union. Results Using the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate. Conclusion Using the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars. Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment.

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“…In symptomatic cases, screws must be removed [9]. Additionally, it is in the interest of various patients to avoid keeping unnecessary surgical hardware once bone healing has been achieved [10].…”

Section: Introductionmentioning

confidence: 99%

Magnesium‐Based Compression Screws in Acute Scaphoid Fractures and Nonunions

2023

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Background Magnesium-based bioabsorbable osteosynthesis material continues to receive increasing attention. The following study documents our experience with bioabsorbable magnesium screws in scaphoid fracture treatment in hopes to capture further evidence and successful application. Methods Eight acute scaphoid fractures and four nonunions were treated with the magnesium-based bioabsorbable compression screw MAGNEZIX Ò . Objective outcome was assessed by X-ray imaging and/or CT scan for bone healing. Clinical assessment was achieved using the modified Mayo Wrist Score. Patient-reported outcome measure was performed threefold via QuickDASH, PRWE, and EQ-5D-5L questionnaires in all patients. Follow-up was 32.5 months (SD 18.7) in the acute fracture group and 31 months (SD 7.4) in the nonunion group. Results Bone healing was achieved in all eight patients with acute scaphoid fractures and in three of four patients with scaphoid nonunion. The modified Mayo Wrist Score was 95 (SD 7.1) in fractures and 80 (SD 7.1) in nonunion patients during follow-up. QuickDASH score was 3.9 (SD 5.8) in fracture and 19.3 (SD 10.6) in nonunion patients. All but one patient (87,5%) with scaphoid fractures presented with a full health state during follow-up (EQ-5D-5L). Nonunion patients had problems in 10 out of 19 dimensions in EQ-5D-5L. Acute fractures presented with a score of 3.9 (SD 7.9) and nonunions with a score of 19.7 (SD 32.4) in PRWE total scoring during follow-up. Conclusions Magnesium-based implants have excellent clinical outcomes when used for scaphoid fractures in eight presented cases and good to moderate clinical outcomes when used for nonunions in three of four presented cases. Additional studies are required to further analyze the differentiated applicability in scaphoid nonunion as well as overall performance when compared to non-absorbable screws in larger cohorts.

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Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

Cited by 10 publications

References 34 publications

Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review

Arthroscopic surgery for scaphoid nonunion: a 10-year systematic literature review

Treatment of scaphoid fractures and pseudarthroses with the human allogeneic cortical bone screw. A multicentric retrospective study

Magnesium‐Based Compression Screws in Acute Scaphoid Fractures and Nonunions

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