Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis

Kim, Jihyeung; Park, Jin Woo; Chung, Jeehyeok; Bae, Kee Jeong; Gong, Hyun Sik; Baek, Goo Hyun

doi:10.1177/1753193417730657

Cited by 27 publications

(19 citation statements)

References 34 publications

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“…According to our results, VBGs as more sophisticated and resource intensive techniques should be used to support biology of bone healing if needed and not only to replace absent vascularity. This confirms two recent studies that reported the success of NVBGs, independent of proximal pole vascularity [ 15 , 16 ].…”

Section: Discussionsupporting

confidence: 91%

“…The use of non-vascularized autologous bone grafts has proven to be effective in specific situations [ 8 – 10 ]. In the case of an avascular proximal fracture fragment, vascularized bone grafting is the recommended treatment [ 11 – 14 ], but there are different opinions on the necessity of vascularized vs. non-vascularized bone grafting [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Schmidle

Ebner

Klauser

et al. 2018

Arch Orthop Trauma Surg

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IntroductionFor the treatment of scaphoid non-unions (SNU), different surgical techniques, including vascularized and non-vascularized bone grafts, are applied. Besides stability, vascularity, and the biological situation at the non-union site are important for healing and the appropriate choice of treatment. We assessed the healing potential of SNUs by histological parameters and compared it to CT parameters of bone structure and fracture location. Based on the results, we developed a CT classification and a treatment algorithm to impact graft selection in SNU surgery.Patients and methodsPreoperative 2D-CT reformations of 29 patients were analyzed for trabecular structure, sclerosis, and fragmentation of the proximal fragment. The fracture location was assessed on 3D-CT reconstructions and grouped in three zones depending on the potential blood supply. Samples were taken during surgery for histological evaluation. Histological parameters of bone healing were defined and a bone healing capacity score (BHC), reflecting histological bone viability, was calculated. CT findings were compared to BHC, age of SNU, and time to union.ResultsCases with trabecular structure and without fragmentation showed a statistically significant higher BHC. Time to union was significantly faster if trabecular structure was present and sclerosis was absent. In intraarticular proximal pole non-unions, where no blood supply is assumed, the BHC was statistically significantly lower and time to union was longer compared to SNUs of the other locations. A statistically significant correlation between BHC and time to union was found in the proximal and distal fragment with higher BHC associated with faster healing.ConclusionsCT parameters of bone structure and fracture location can reflect histological healing capacity of SNUs. This can guide bone graft selection in SNU surgery.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Schmidle

Ebner

Klauser

et al. 2018

Arch Orthop Trauma Surg

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“…In addition to large bone defect filling, the open volar approach is also advantageous in correction to the humpback deformity, scaphoid length and DISI [12,25] ( Table 3). A literature review regarding the wrist functional recovery course after scaphoid nonunion surgery is presented in Table 4 [25][26][27][28][29][30][31][32][33][34][35]. The union rates ranged from 84.6 to 97.1% for open surgeries and 86 to 100% for arthroscopic surgeries.…”

Section: Discussionmentioning

confidence: 99%

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

et al. 2020

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Background 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 14.3 weeks. Compared to the preoperative status, the grip strength, wrist motion arc, and Mayo Wrist score were improved significantly 6 months after surgery, whilst 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, motion arc, Mayo Wrist score and finally the DASH score at postoperative 6 months and 12 months, respectively.

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“…A literature review regarding the wrist functional recovery course after scaphoid nonunion surgery is presented in Table 4. (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The union rates ranged from 84.…”

Section: Discussionmentioning

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

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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.

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Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis

Abstract: IV.

Cited by 27 publications

References 34 publications

Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

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

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