Percutaneous Screw Fixation of Scaphoid Waist Fracture Non-Union Without Bone Grafting

Hegazy, Galal

doi:10.1007/s12593-015-0194-2

Cited by 23 publications

(23 citation statements)

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“…More recent studies have continued to demonstrate union rates of 85.7% to 100% with 91.7% to 100% of patients returning to previous work or activity levels. 2,3,5,12,16 Somerson et al 3 had the lowest union rate (85.7%), but that cohort had a mean delay of treatment of 13.6 months from injury compared with less than a year for most others. 1,5,6,12,16 In addition, most of the nonunions involved the proximal pole.…”

Section: Rationale For Screw Fixation Alonementioning

confidence: 98%

“…Several techniques require a second incision, 1,7,8,15,25 and formal grafting often requires an open approach with disruption of the capsule and ligaments and potential danger to the dorsal radial artery. 12,13,16 Garcia-Elias et al 30 found that an open volar approach resulted in increased scapholunate and lunocapitate angles, facilitating carpal collapse. Conversely, a recent meta-analysis found no difference in outcomes between approaches.…”

Section: Rationale For Treatmentmentioning

confidence: 99%

“…33 Many studies require the presence of this stable, fibrous component to proceed with fixation-only techniques. 6,12,14,16 CURRENT EVIDENCE Union rates of stable nonunions treated with fixation alone have been reported as high as 100%. 2,5,6,14,16,25,34 It should be noted however, that there may be some degree of bias and confounding with the reported union rates to consider when evaluating these data given varying means or criteria by which union was assessed by the authors.…”

Section: Rationale For Screw Fixation Alonementioning

confidence: 99%

“…The presence of an intact cartilaginous envelope or firm, fibrous nonunion assessed via advanced imaging or direct visualization 6,16,25,32 (Fig. 1).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

“…Several authors have based their treatment algorithms on this system. 2,13,14,16 NATURAL HISTORY OF SCAPHOID FRACTURE NONUNION Scaphoid fracture nonunions may follow a predictable path toward posttraumatic arthrosis, with each decade after injury potentially demonstrating more severe arthritic changes in symptomatic patients, although the natural history of the condition is not known with certainty. 18,19 In 1 study with 30-year follow-up, arthritis was found in 56% of patients with nonunion versus 2% of patients with a healed scaphoid fracture.…”

mentioning

confidence: 99%

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Screw Fixation Alone for Scaphoid Fracture Nonunion

Ernst

Green

Saucedo

2018

The Journal of Hand Surgery

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Scaphoid fracture nonunion can often lead to pain, arthrosis, and disability. While typically the result of delayed diagnosis or inadequate treatment, it can sometimes occur even if the initial care was timely and appropriate. Whereas early recognition of acute fractures allows for nonoperative management, nonunions frequently require surgical treatment. Traditionally, this has involved open debridement and bone grafting. However, some publications suggest that certain stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting. Although certain characteristics appear to be appropriate indications for such management, well-designed clinical studies are needed to better define them.

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Section: Rationale For Screw Fixation Alonementioning

confidence: 98%

Section: Rationale For Treatmentmentioning

confidence: 99%

Section: Rationale For Screw Fixation Alonementioning

confidence: 99%

“…The presence of an intact cartilaginous envelope or firm, fibrous nonunion assessed via advanced imaging or direct visualization 6,16,25,32 (Fig. 1).…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Screw Fixation Alone for Scaphoid Fracture Nonunion

Ernst

Green

Saucedo

2018

The Journal of Hand Surgery

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Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Chen,

Wang,

Tang

2023

Microsurgery

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BackgroundFree vascularized bone grafting (FVBG) has become one of the essential methods for treating scaphoid nonunion complicated by avascular necrosis. However, commonly used bone graft, including the medial femoral condyle bone graft and iliac crest bone graft, still present challenges such as a high rate of donor site complications and variations of vascular pedicle. In this study, we have introduced a novel bone graft—the lateral humeral condyle bone graft with the posterior branch of the radial collateral artery (PBRCA) as the vascular pedicle—as an alternative option, with the aim of overcoming some of the limitations of previously described FVBG procedures.MethodsNine patients who had a nonunion of the scaphoid that had been present for an average of 16.8 months (range 9–35 months) were managed with use of a free vascularized bone graft obtained from the lateral humeral epicondylar region. Avascularity of the scaphoid, as assessed on preoperative magnetic resonance imaging and intraoperative bone marrow puncture test. Postoperatively, regular X‐ray and CT scans examinations were conducted to assess the progress of fracture healing. Active motion of the wrist, and grip strength recovery were measured periodically. Wrist pain was graded using the Visual Analogue Scale (VAS), while wrist joint functionality was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH) questionnaire and the Patient‐Rated Wrist Evaluation (PRWE) scale. The elbow functional outcome was evaluated by the Mayo Elbow Performance Score (MEPS).ResultsAll of nine lateral humeral epicondylar bone grafts were successfully harvested. The blood supply of the graft during surgery was excellent in six cases and good in three cases. The size of the bone grafts ranges from 1.0 cm × 0.5 cm × 0.5 cm to 2.0 cm × 1.0 cm × 0.5 cm. The average vascular pedicle length was 3.4 cm (range 2.0–6.0 cm). There were no early complications in either the donor or recipient areas after surgery. Union was successfully achieved in all nine patients, with an average time to union of 14.3 weeks (range 11–20 weeks) after surgery. The average follow‐up period was 31.2 months (range 26–40 months). At the final follow‐up, the average palmar flexion, dorsal extension, radial deviation, and ulnar deviation angles of the injured wrist joint were 56.1° (range 45°–70°), 56.1° (range 40°–80°), 10.6° (range 5°–20°), and 22.2° (range 15°–35°), respectively, which reached 79.0%, 82.1%, 59.4%, and 72.8% of the average activity of the contralateral normal side. The average grip strength of the injured side was 35.2 kg (range 22–51 kg), which was equivalent to 81.3% of the average grip strength of the contralateral side. The average VAS score for wrist joint pain was 1.0 point (range 0–2 points); the Quick‐DASH score was 9.2 points (range 6–18 points); and the PRWE score was 13.1 points (range 9–16 points), the Mayo Elbow Performance Index was 100 points (range 100–100 points). One patient reported a feeling of friction during movement but no pain. One patient reported numbness in the donor site. One patient complained of pain when applying force to the scar in the donor area. During the follow‐up period, these complications showed improvement without any treatment.ConclusionThe FVBG technique has been considered an effective method for treating scaphoid nonunion with avascular necrosis. Compared to traditional FVBG, the lateral humeral epicondylar bone graft exhibits a higher union rate, fewer complications, and easier accessibility, making it a favorable choice.

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