Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Munk, Bo; Larsen, Claus Falck

doi:10.1080/00016470410001529

Cited by 150 publications

(128 citation statements)

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“…Bone union was achieved in 80-90% of patients, excluding those with a fracture in proximal pole, which were associated with blood flow impairment. In those cases, the percentage of bone union did not exceed 50% (11,12,18). From the 1990s on, the use of vascularised bone grafts significantly improved outcomes, particularly in cases of avascular necrosis of the proximal pole.…”

Section: Discussionmentioning

confidence: 96%

“…This score included as- [6][7][8][9][10][11][12][13][14][15][16][17][18] and included measurements of the same variables. In addition, an X-ray was taken to assess bone union which was classified with Dias criteria (17).…”

Section: Methodsmentioning

confidence: 99%

“…From 2005 to 2006, 11 patients, 9 males and 2 females, of an average age of 29 years (range 19-45) with scaphoid nonunion lasting a mean of 10 months (range [8][9][10][11][12][13][14][15][16][17][18][19][20] were operated on in the Department of General and Hand Surgery, Pomeranian Medical University. The most common mechanism of injury was a fall on a hand in nine cases.…”

Section: Methodsmentioning

confidence: 99%

“…Delayed union or nonunion is an indication for surgery (3,4,8). Classical management includes debridement of the nonunion, followed by osteosynthesis with K-wires, Herbert screws or headless canullated screws with or without bone grafting (4,(9)(10)(11)(12)(13). Some authors choose the method of treatment based on the site of the facture and vascularity of the bone fragments (4).…”

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confidence: 99%

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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Żyluk¹,

Walaszek²

2008

Polish Journal of Surgery

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Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist. The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius. Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score. Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Żyluk¹,

Walaszek²

2008

Polish Journal of Surgery

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“…In a recent review of outcomes for adult scaphoid nonunion, Munk and Larsen reported an overall union rate of 80% after an average of 105 days in patients undergoing nonvascularized bone grafting without internal fixation, 84% after an average of 49 days in nonvascularized bone grafting with internal fixation, and 91% after an average of 70 days in vascularized bone grafting with or without internal fixation. 15 This report was a review of published literature over a 75-year period and therefore has limitations common to these types of studies, including the inclusion of variable study designs and surgical techniques employed. In a recent clinical report, Waitayawinyu et al reported a union rate of 93% in 30 consecutive patients with scaphoid nonunion treated with vascularized bone grafting.…”

Section: Discussionmentioning

confidence: 99%

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

et al. 2015

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).Attempts by clinicians to maximize the healing potential of nonunions have led to the use of adjunctive treatment modalities such as low-intensity pulsed ultrasound therapy. The safety and efficacy of low-intensity pulsed ultrasound in the treatment of fracture nonunion has been previously investigated, 1-6 and this technology is approved in the United States by the Food and Drug Administration (FDA) for treatment of fracture nonunion in adults. Several recent studies of this adjunctive treatment modality have included a percentage of scaphoid fractures. Nolte et al reported on 29 cases of established fracture nonunion in a variety of anatomic locations, including five scaphoid fractures. 3 The majority of these cases were treated with prior surgery. Following failure of treatment, the nonunions were subjected to ultrasound therapy; 86% went on to healing in a mean time of 22 weeks. Of the scaphoid nonunions, four out of five demonstrated healing at a mean interval of 143 days. Similarly, Gebauer et al reported on 67 nonunions, including six scaphoid nonunions, treated with ultrasound therapy. 1 Healing occurred in 85% of the patients without additional surgical treatment. Rubin et al analyzed ultrasound prescription registry data to examine the effects of ultrasound on nonunion. 4 The registry subcategorized fracture nonunion by anatomic location, and the reviewing authors found that 101 out of 118, or 86%, of scaphoid fracture nonunions healed following ultrasound therapy. Rubin et al did not assess the registry data for other Keywords ► scaphoid fracture ► scaphoid nonunion ► pulsed ultrasound ► adolescents ► adjunctive therapy AbstractBackground Treatment of scaphoid nonunion is challenging, leading clinicians to pursue innovation in surgical technique and adjunctive therapies to improve union rates. Purpose The purpose of this study was to investigate the use of low-intensity pulsed ultrasound as an adjunctive treatment modality following surgical treatment of scaphoid nonunion in adolescent patients, for whom this therapy has not yet been FDA-approved. Patients and MethodsWe performed a retrospective review of adolescent patients with scaphoid nonunion treated surgically followed by adjunctive low-intensity pulsed ultrasound therapy. All patients underwent 20 minutes of daily ultrasound therapy postoperatively until there was evidence of bony healing, based on both clinical and radiographic criteria. Final healing was confirmed by > 50% bone bridging on CT scan. Results Thirteen of fourteen (93%) patients healed at a mean interval of 113 days (range 61-217 days). There were no surgical or postoperative complications. One patient developed heterotopic bone formation about the scaphoid. Conclusions Our study suggests that low-intensity pulsed ultrasound therapy can safely be utilized as an adjunctive modality in adolescents to augment scaphoid healing following surgical intervention. Level of Evidence Level IV, Case series

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Scaphoid Nonunions

Bulstra

Doornberg

Obdeijn

et al. 2021

Evidence‐Based Orthopedics

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Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Cited by 150 publications

References 71 publications

Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Low-Intensity Pulsed Ultrasound Treatment for Scaphoid Fracture Nonunions in Adolescents

Scaphoid Nonunions

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