Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Altay, Taşkın; Günal, İzge; Kayalı, Cemil; Şener, Muhittin

doi:10.1007/s00264-014-2282-5

Cited by 7 publications

(6 citation statements)

References 12 publications

(23 reference statements)

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“…Ultimately, 23 studies were included for final data extraction and analysis. 11,12,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] ►Fig. 1 outlines the results of the literature search and article selection.…”

Section: Resultsmentioning

confidence: 99%

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

et al. 2021

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Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions. Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution. Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores. Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.

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Section: Resultsmentioning

confidence: 99%

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

et al. 2021

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“…Vanhees et al 15 have reported achieving 94% union in a case series of 16 patients treated using a percutaneous technique where the mean time to union was 4 months (17 weeks). Recently, favorable results and high union rates with percutaneous techniques have been reported in multiple studies, [12][13][14] although the exact time to union has not been reported in all the studies. The major risk factors involved in the failure of treatment for this condition are the duration between the injury and the surgical treatment, as well as the localization of the nonunion in the proximal pole 25 (►Fig.…”

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.…”

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confidence: 99%

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

et al. 2019

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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.

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“…Interosseal vascularization of the proximal bone pole (70-80%) originates from the radial artery branch which enters the bone along the dorsal ridge at the level of the waist. Given such anatomy, after a fracture there is a risk of vascular insufficiency and consequential development of avascular necrosis [5], particularly of the upper bone pole [1]. Delay in diagnosis leads to a variety of adverse outcomes such as delayed union, nonunion, decreased grip strength, smaller range of motion, and osteoarthritis of the radiocarpal joint [6].…”

Section: Introductionmentioning

confidence: 99%

Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion

Matić

Vuckovic²,

Lešić

et al. 2020

International Orthopaedics (SICOT)

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Introduction Fractures of the scaphoid account for 60-70% of all wrist bone fractures. The results of treatment in terms of bone healing vary depending on the type and location of the fracture, the time elapsed since the injury, the type of surgical treatment. Nonunion occurs in 5-15% of the cases on average. The purpose of this paper is to compare the surgical techniques and results of treating scaphoid nonunion (SNU) with osteoplastic xenografts of bovine origin or a vascularized autograft of the distal part of the dorsal radius. Methods We compare two groups of patients with symptomatic SNU, treated surgically with either a vascularized graft (n = 15) or a xenograft of bovine origin (n = 15). In the presurgical stage, the demographic characteristics of the patients, the time elapsed between injury and surgery, and classification of the injury (Schonberg, Herbert-Fisher, and Geissler-Slade) were recorded. One year following surgery, bone healing, total duration of the treatment, complications, the Mayo wrist score, and answers to the DASH questionnaire were analyzed.Results No statistically significant differences between the two groups of patients were observed for bone healing (86.7% vs 80%) or functional results. A highly significant difference was observed with respect to duration of the surgical intervention in favor of xenografts. Conclusion The xenograft method is simple and relatively acceptable, providing good results in terms of healing and functionality.

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Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Cited by 7 publications

References 12 publications

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

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

Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion

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