Percutaneous fixation of selected scaphoid fractures by dorsal approach

Naranje, Sameer; Kotwal, Prakash; Shamshery, Prasoon; Gupta, Vikas; Nag, Hira Lal

doi:10.1007/s00264-009-0891-1

Cited by 25 publications

(28 citation statements)

References 27 publications

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“…However, open approaches, either dorsal or palmar, have some certain problems including soft tissue stripping, damage to ligaments, especially radioscaphocapitate and radiolunate ligaments leading to instability, injury to the already damaged blood supply leading to AVN, infection, reflex sympathetic dystrophy, painful scar formation and stiffness [1-6, 8, 10-12]. For these reasons, there has been a trend towards percutaneous fixation of such fractures [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Review of the literature revealed a limited number of case series of dorsal percutaneous fixation of scaphoid delayed or nonunions [2][3][4][5] and none of them reported AVN. On the other hand, AVN is the most important complication of scaphoid fractures and occurs due to the disruption of precarious blood supply [1,8], and the risk for AVN increases if the fracture is left untreated [1].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some articles indicating dorsal percutaneous screw fixation without bone grafting appeared in the literature, all with excellent results [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Altay

Günal

Kayalı

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of the present study is to evaluate scaphoid delayed fractures or nonunions treated by percutaneous fixation with MRI correlations. Methods We evaluated 33 consecutive scaphoid delayed unions or nonunions treated by dorsal percutaneous fixation at a mean 16 months (range, seven to 48 months) after the operation. There were 31 male and two female patients with an average age of 29 years (range, 25-33 years). Results Pre-operative MRI revealed no signs of avascular necrosis. At the latest follow-up, all patients had good or excellent results. Conclusion We suggest dorsal percutaneous screw fixation for scaphoid delayed fractures or nonunions after eliminating the presence of AVN by pre-operative MRI examination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Altay

Günal

Kayalı

et al. 2014

International Orthopaedics (SICOT)

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“…It has been shown in biomechanical and clinical study that central placement of a scaphoid screw improves the healing rate and reduces the immobilisation period of a scaphoid fracture [10,13,18]. Trumble et al [18] reported that the scaphoid screw located in the central scaphoid was associated with shorter union time based on their clinical data of 34 patients.…”

Section: Discussionmentioning

confidence: 99%

Establishing a central zone in scaphoid surgery: a computational approach

Guo

Tian

Chen

et al. 2013

International Orthopaedics (SICOT)

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Purpose Scaphoid fractures are commonly fixed with headless cannulated screws positioned centrally in the scaphoid. Judgement of central placement of the screw may be difficult. We generated a central zone using computer analysis of 3D reconstructions of computed tomography (CT) images. As long as the screw axis is completely contained within this central zone, the screw would be considered as centrally placed. Methods Thirty cases of 3D CT reconstructions of normal scaphoids in a computerised operation planning and simulation system (Vxwork software) were obtained. The central zone was established after some distance shrinkage of the original scaphoid surface reconstruction model using the function "erode" in the software. The shape of the central zone was evaluated, and the width of the central zone in the proximal pole, waist portion and distal pole was measured. We also established the long axis of the scaphoid to see whether it stays in the central zone. Results All central zones could be divided into distal, waist and proximal portions according to the corresponding irregular shape of the scaphoid. As the geometry of the central zone was so irregular and its width very narrow, it was possible to completely contain the screw axis either in the proximal portion alone, waist alone or distal central zone alone. Conclusions Establishing the central zone of scaphoid 3D CT images provided a baseline for discussion of central placement of a scaphoid screw. The geometry of the scaphoid central zone determined that the screw could hardly be inserted through entire scaphoid central area during surgery.

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“…presentations with dorsal approach. 20 Similarly Shin AY et al found that the fracture union occurred at an average of 7.1 week compared to 11.6 weeks with cast treatment using volar percutaneous fixation for stable scaphoid fracture. 23 Reported union rates and complication rates with the percutaneous technique ranged from 94% to 100% and 0% to 30%, respectively.…”

Section: Original Articlementioning

confidence: 96%

Scaphoid Fracture: Functional Outcome Following Fixation with Herbert Screw

Parajuli

Shrestha

Dhoju

et al. 2012

Kathmandu Univ. Med. J.

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BackgroundMost scaphoid fractures though heal uneventfully with cast treatment, immobilization with cast is associated with complication like wrist stiffness. Open reduction and fixation with Herbert Screw though technically demanding procedure can yield excellent results and prevents complication like nonunions and loss of wrist function. ObjectivesTo assess clinical outcome and radiological union of scaphoid fracture after operative management following Herbert screw fixation in patient attending Dhulikhel Hospital. MethodsAll scaphoid fracture, treated from Feb 2007 till Feb 2011, were retrospectively studied in Dhulikhel Hospital, Kathmandu University Hospital. Fifteen patients with scaphoid fractures were treated with Herbert screw. Fourteen were males and one was female. Serial radiographs were taken to assess radiographic union and functional outcome was assessed using Modified Mayo wrist score. ResultsOut of 15 patients, 13 scaphoid had waist fractures and two had proximal pole factures. All scaphoid were treated with open reduction and Herbert screw fixation either by volar approach or by dorsal approach. All fractures maintained good alignment post operatively. Nine (60%) patients had excellent results with normal wrist range of motion, five (33.3%) patients had good results and one (6.7%) patient had poor outcome. In 14 (93.3%) patients good radiological union was seen at final follow up at six months time. ConclusionFixation with Herbert screw for scaphoid fracture is an effective and convenient way of treatment with satisfactory functional outcome and less complication. KEY WORDSscaphoid fracture, Herbert screw, functional outcome scaphoid fracture or with delayed union have expanded from open surgical technique to percutaneous fixation technique that reliably expedite fracture healing and return to work/ sport relative to traditional cast treatment.Predicting successful scaphoid healing after a fracture can be difficult because reported union rates range between 10% and 50% with traditional cast treatment. 5,6 The most influential factors for nonunion includes displaced fractures, fractures with ligamentous injuries and proximal pole fractures. Long term studies confirm a 10% to 12%

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Percutaneous fixation of selected scaphoid fractures by dorsal approach

Cited by 25 publications

References 27 publications

Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Dorsal percutaneous screw fixation of delayed or nonunion of scaphoid fractures

Establishing a central zone in scaphoid surgery: a computational approach

Scaphoid Fracture: Functional Outcome Following Fixation with Herbert Screw

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