Arthroscopic grafting of scaphoid nonunion – surgical technique and preliminary findings from 23 cases

Cognet, J.-M.; Louis, Pascal; Martinache, X.; Schernberg, F.

doi:10.1016/j.hansur.2016.11.002

Cited by 32 publications

(30 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, there are very few studies that have assessed scaphoid nonunions and associated intra-articular pathologies using wrist arthroscopy. 7,8,13,14 All these studies had strict inclusion and exclusion criteria and concentrated more on the arthroscopic technique of scaphoid ORIF and outcome than assessing associated intra-articular pathology. Ours is the first study to provide detailed intra-articular assessment of entire spectrum of concomitant pathology in established scaphoid nonunion.…”

Section: Discussionmentioning

confidence: 99%

Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion

Karuppaiah

Ali

Colegate-Stone

et al. 2020

Journal of Hand and Microsurgery

View full text Add to dashboard Cite

Background Patients with scaphoid nonunion and wrist pain may have a wide spectrum of potential concomitant pathologies that may be diagnosed and potentially managed arthroscopically. Purpose The aim of this study is to assess the usefulness of wrist arthroscopy in the assessment and treatment of scaphoid nonunion and any associated injuries. Materials and Methods We retrospectively reviewed 34 consecutive patients with established scaphoid nonunion between January 2006 and December 2012 who had undergone arthroscopic assessment. The average age of the patients was 40 years (range: 25–64), and all the patients had arthroscopic assessment of the wrist joint before definitive surgery. The patients with associated intra-articular problems, which could be addressed along with the scaphoid open reduction internal fixation (ORIF) and bone grafting (BG), had definite procedure in the same sitting. However, if the patients had major intra-articular pathology that needed change in the management plan, they had staged definitive treatment after discussing with them about the arthroscopic findings. Results Arthroscopic assessment of the 34 joints showed varying degrees of arthritis affecting radioscaphoid joint (41%) followed by injuries to the triangular fibrocartilage complex (TFCC) (35%), lunotriquetral ligament (LTL) tears (32%), and scapholunate ligament (SLL) injuries (26%). Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (62%), TFCC debridement (32%), loose body removal (17%), and DRUJ stabilization and TFCC repair (3%). Twenty-nine patients had arthroscopy and definitive procedure in the same sitting, and the remaining had staged or delayed definitive treatment. Conclusion Our study highlights the usefulness of wrist arthroscopy in assessment and management of the scaphoid nonunion and associated pathologies. Besides in 18% of our patients, the initial management plan changed after arthroscopy. Level of Evidence This is a Level IV study.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion

Karuppaiah

Ali

Colegate-Stone

et al. 2020

Journal of Hand and Microsurgery

View full text Add to dashboard Cite

show abstract

“…(3) Compared to the preoperative status, the grip strength and Mayo wrist score were the earliest recovered wrist function parameters that had signi cant improvements at 6 months postoperatively, followed by the motion arc at 9 months, and nally the DASH score at 12 months postoperatively.. Arthroscopic surgery has the advantages of direct visualisation, facilitated debridement of the scaphoid nonunion site, and minimal violation of the scaphoid vascularity (7). High union rates of approximately 84-100% are reported with this method (11)(12)(13)(14). Though this minimally invasive technique has yielded good results with minimal morbidity, its use is still limited to scaphoid nonunion without a large bone defect.…”

Section: Discussionmentioning

confidence: 99%

“…The operated hand was measured as a percentage of the normal side. Considering whether the dominant or nondominant hand was injured, we employed the 10% rule for data correction [13][14][15]. The active wrist exion-extension arcs for the operated and non-operated hands were measured with the manual universal goniometer.…”

Section: Clinical Evaluationsmentioning

confidence: 99%

Wrist Function Recovery Course in Patients with Scaphoid Nonunion Treated with Combined Volar Bone Grafting and a Dorsal Antegrade Headless Screw

Hsu

Wang

Chiu

2020

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…Other studies of arthroscopically assisted techniques have reported good or excellent union rates and functional results. 16,18,20 Mahmoud and Koptan 11 have reported achieving 100% union rate in 27 patients at a mean of 12 weeks using a percutaneous technique without bone grafting where patients with humpback deformity did not undergo the treatment. The authors found a correlation between the time from injury to surgery and healing time.…”

Section: Discussionmentioning

confidence: 99%

“…The union rate and healing potential with percutaneous [11][12][13][14][15] and arthroscopically assisted [16][17][18][19][20] techniques for the treatment of scaphoid nonunion have not been discussed at length. Indeed, comparative studies of different treatment options are rare in the literature.…”

mentioning

confidence: 99%

Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone

et al. 2019

View full text Add to dashboard Cite

Purpose Minimally invasive techniques have been recommended in the treatment of painful but stable scaphoid nonunions. The purpose of this study was to determine if arthroscopically assisted bone grafting provided superior results in healing as compared to percutaneous screw fixation. Materials and Methods One hundred sixty-four consecutive patients with scaphoid nonunions were retrospectively analyzed. One hundred forty-eight patients were treated with the open grafting techniques either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n = 8), the time from injury to surgery was 2.5 months (range: 2–4 months) and it was 27.3 months (range: 3–180 months) in the arthroscopic group (n = 8). The mean age was 39 years (range: 20–66) in the percutaneous group and 22 years (range: 16–32) in the arthroscopic group. In all cases, the Mini Acutrak headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks, mean 7 months (range: 3–12 months). Data were calculated with two-tailed Mann–Whitney U test based on p-value of < 0.05 that was considered statistically significant. Results We recorded no complications in any of the groups. Patients treated arthroscopically received cancellous bone grafting from the distal radius and all patients but one healed at a median of 7.8 weeks (range: 5–18 weeks). Seven patients in the percutaneous group healed at a mean of 10.5 weeks (range: 7–24 weeks), thus leaving one patient from each group without achieving union. Mann–Whitney U test showed the U value of 11, the critical value of U to be 13 (p < 0.05), thus significantly faster healing was observed in the arthroscopically treated group. Conclusions Arthroscopically treated patients achieved faster healing despite shorter time to surgery in the percutaneous group. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. Level of Evidence This is a Level III comparative study.

show abstract

Arthroscopic grafting of scaphoid nonunion – surgical technique and preliminary findings from 23 cases

Cited by 32 publications

References 20 publications

Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion

Role of Wrist Arthroscopy in the Management of Established Scaphoid Nonunion

Wrist Function Recovery Course in Patients with Scaphoid Nonunion Treated with Combined Volar Bone Grafting and a Dorsal Antegrade Headless Screw

Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone

Contact Info

Product

Resources

About