Prognostic Factors in the Treatment of Carpal Scaphoid Nonunions

Schuind, Frédéric; Haentjens, Patrick; Innis, F. Van; Maren, C. Vander; García-Elias, Marc; Sennwald, G

doi:10.1053/jhsu.1999.0761

Cited by 131 publications

(124 citation statements)

References 115 publications

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“…Success treating nonunion of the scaphoid is measured by consolidation, reestablishment of the shape of the scaphoid, pain relief, and recovery of the normal mobility and biomechanics of the wrist [24]. When consolidation of the nonunion is not achieved, the outcome is generally poor: patients develop persistent pain, joint stiffness, and radiocarpal arthritis [25].…”

Section: Discussionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to correlate the preoperative imaging, vascularity of the proximal pole, and histology of the proximal pole bone of established scaphoid fracture non-union. Methods This was a prospective non-controlled experimental study. Patients were evaluated pre-operatively for necrosis of the proximal scaphoid fragment by radiography, computed tomography (CT) and magnetic resonance imaging (MRI). Vascular status of the proximal scaphoid was determined intra-operatively, demonstrating the presence or absence of puncate bone bleeding. Samples were harvested from the proximal scaphoid fragment and sent for pathological examination. We determined the association between the imaging and intra-operative examination and histological findings. Results We evaluated 19 male patients diagnosed with scaphoid nonunion. CT evaluation showed no correlation to scaphoid proximal fragment necrosis. MRI showed marked low signal intensity on T1-weighted images that confirmed the histological diagnosis of necrosis in the proximal scaphoid fragment in all patients. Intra-operative assessment showed that 90 % of bones had absence of intra-operative puncate bone bleeding, which was confirmed necrosis by microscopic examination. Conclusions In scaphoid nonunion MRI images with marked low signal intensity on T1-weighted images and the absence of intra-operative puncate bone bleeding are strong indicatives of osteonecrosis of the proximal fragment.

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Section: Discussionmentioning

confidence: 99%

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Bervian

Ribak

Livani

2014

International Orthopaedics (SICOT)

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“…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%

“…The normal course of nonunion indicates that over 10 years, it definitively leads to radio-carpal joint arthritis (7). Therefore, nonunion of the scaphoid bone is an indication for operative treatment in order to achieve bone union and an adequate shape of the bone (4,8).…”

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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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“…They may be treated by electric or electromagnetic stimulation [6] , bone grafting [7] , internal fixation [8] , vascularized bone grafting [9,10] , and combined methods [11] . Fracture healing failure rate with non-union persistence is also high, with prolonged immobilization [7] , prevent patients to perform their professional work, not only during rehabilitation period, but also during postoperative rehabilitation, leads to serious socioeconomic problem [2] . Degenerative changes occur if scaphoid fracture non-union is left untreated.…”

Section: Introductionmentioning

confidence: 99%

Scaphoid Fractures Treated With Kirschner (K) Wires or Herbert Screw Fixation Has No Difference in Fracture Healing Period

Kumar¹

2016

jmscr

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Prognostic Factors in the Treatment of Carpal Scaphoid Nonunions

Cited by 131 publications

References 115 publications

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

Scaphoid fracture nonunion: correlation of radiographic imaging, proximal fragment histologic viability evaluation, and estimation of viability at surgery

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

Scaphoid Fractures Treated With Kirschner (K) Wires or Herbert Screw Fixation Has No Difference in Fracture Healing Period

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