Proximale Kahnbeinpseudarthrose - Rekonstruktion durch dorsale Verschraubung und Spongiosa-Transplantation

Krimmer, H.; Kremling, Elisabeth; Schoonhoven, Jörg van; Prommersberger, K.-J.; Hahn, Philip M.

doi:10.1055/s-1999-13517

Cited by 26 publications

(14 citation statements)

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“…The articles mostly dealt with nonunions in all parts of the scaphoid, but there were a few that exclusively concerned proximal pole scaphoid nonunion with a union rate of 78 (CI: 73-84)% after an average immobilization period of 9 weeks in 223 cases (Bohler and Ender 1986, DeMaagd and Engber 1989, Robbins et al 1995, Inoue et al 1997b, Herbert and Filan 1999, Krimmer et al 1999, Wilhelm and Wilhelm 1999, Del Pinal 2001 (Table 2). …”

Section: Resultsmentioning

confidence: 99%

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Munk¹,

Larsen²

2004

Acta Orthopaedica Scandinavica

150

106

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Section: Resultsmentioning

confidence: 99%

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Munk¹,

Larsen²

2004

Acta Orthopaedica Scandinavica

150

106

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“…Main disadvantage of conservative treatment is a residual risk of developing nonunion and long immobilization. The conservative treatment appears doubtful given the percentage of patients -1.5-37%, depending on authors [4] -with scaphoid nonunions [41] or at least developing carpal collapse (SNAC-wrist) [33]. Improved materials for osteosynthesis justify the fact that the indication for surgical proceeding has been made more generously in recent years [6].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, scaphoid nonunion is treated in most hand centers either from dorsally or palmarly with screw osteosynthesis and interposition of a corticocancellous bone block [32,33] (Figures 6a to 6d). This procedure restores realignment of the carpus and prevents further carpal collapse.…”

Section: Scaphoid Nonunionmentioning

confidence: 99%

Current Concepts in the Treatment of Scaphoid Fractures

Sauerbier

Germann

Dacho

2004

European Journal of Trauma

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Fractures of the carpus are frequent injuries and typically result from of a fall onto the outstretched hand. Scaphoid fractures are the second most frequent fracture type of the hand (80%). 95% of the patients with acute scaphoid fractures are male, and the average age is approximately 25 years. Conservative treatment of acute scaphoid fractures with immobilization in a plaster cast was the therapy of choice for a long time. Surgical treatment was reserved to severe dislocated fractures only. A progress could be obtained by the principle of intramedullary fixation, whose forerunner is represented by the Herbert screw, and the introduction of cannulated screws guaranteed a continuous improvement. The decision to treat the fracture by surgery requires a clear definition of the fracture type. Therefore, precise radiologic technique is mandatory to detect the fracture and to analyze the pathomorphological circumstances. In order to get an exact classification for the decision on how to proceed, three standard X-ray projections (posteroanterior [PA], lateral and Stecher projection) and a CT scan have to be performed. The most well-known classification has been defined by Herbert & Fisher which combines fracture anatomy, stability and disease history in order to derive prognostic and therapeutic criteria. Also, delayed healings and nonunions are considered. To decide on the adequate treatment, a prerequisite for conservative therapy of acute scaphoid fractures is the anatomic position of the scaphoid. Conservative therapy should be reserved to fracture types, which are stable and heal reliably in the lower-arm plaster cast within 6 weeks. All displaced and unstable acute scaphoid fractures should be operated, and whenever possible, rigid internal fixation should be achieved because of interfragmentary compression. Therefore, several intramedullary implants are available for surgical treatment of acute scaphoid fractures, e.g., Herbert screw, Mini Herbert screw, AO screw (cannulated), Acutrac screw (cannulated), or Twin-fix screw (cannulated). With improved surgical and radiologic techniques, most scaphoid fractures are amenable to minimally invasive fixation. The dorsal approach guarantees a good overview in treating proximal pole fractures. Yet, not all types of fractures can be treated in this way. Severely displaced fractures require the classic open palmar approach. In order to prevent the development of a scaphoid nonunion or an advanced carpal collapse (SNAC-wrist), an early and sufficient diagnostic algorithm is necessary. We recommend internal fixation with a cannulated Herbert screw in B1 and B2 fractures and a Mini Herbert screw in fractures of the proximal third (B3). A2 fractures can be treated conservatively. Early diagnosis and operative treatment will shorten the time off work, minimize the risk of nonunion, and reduce the costs of health care in the long term. IntroductionScaphoid fractures are the second most frequent fracture type of the hand. 95% of the patients with acute scaphoid fractures are mal...

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“…Immer noch werden viele Frakturen primär übersehen und bei persistierenden Beschwerden erst im Stadium der Pseudarthrose diagnostiziert [11,15]. Frakturen und Pseudarthrosen im proximalen 1/3 des Skaphoids sind besonders problematisch, da das proximale Fragment aufgrund seiner geringen Größe schwer zu fixieren ist und die Frakturen als instabil gelten [3,16].…”

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Versorgung proximaler Kahnbeinpseudarthrosen und -frakturen mit der Mini-Herbert-Schraube über einen dorsalen Zugang

et al. 2001

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32 patients, aged 16 to 49 years, were treated by osteosynthesis using the Herbert mini screw. The indications were five fractures (type B3, Herbert classification), two delayed unions (type C) and 25 nonunions (type D1 to D3, Filan and Herbert classification). Six patients received no bone grafts, 19 received cancellous bone graft from the radius. An interpositional iliac crest bone graft was used in four, and a vascularized bone graft from the distal radius in three cases respectively. The average postoperative immobilisation in a forearm splint was nine weeks. 26 patients could be recruited for clinical follow-up at an average of 14.5 months. The radiological results were assessed in 30 cases (94%). Bony consolidation was achieved in 26 cases (100% of the fractures, 84% of the nonunions). In three cases a loosening of the screw, and in three further cases a dislocation into the radiocarpal joint were observed. A humpback deformity was present in four cases. Three patients showed a persisting nonunion, one patient a fibrous union. Early degenerative changes of the radiocarpal joint were observed in six cases. The clinical follow up examination showed an average grip strength of 91% (JAMAR II), 94% for the three finger, and 95% for the pinch grip compared to the contralateral side. The mean postoperative pain score on the visual analog scale was one for resting conditions, eleven for motion and 33 under stress. The range of motion was 79% of the opposite side for extension/flexion and 83% for radial/ulnar deviation. The average DASH-score reached 15 points. The Herbert mini screw has proven to be a reliable implant for reconstruction of proximal pole fractures and nonunions of the scaphoid.

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Proximale Kahnbeinpseudarthrose - Rekonstruktion durch dorsale Verschraubung und Spongiosa-Transplantation

Cited by 26 publications

References 0 publications

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Bone grafting the scaphoid nonunionA systematic review of 147 publications including 5 246 cases of scaphoid nonunion

Current Concepts in the Treatment of Scaphoid Fractures

Versorgung proximaler Kahnbeinpseudarthrosen und -frakturen mit der Mini-Herbert-Schraube über einen dorsalen Zugang

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