Radial styloidectomy for scaphoid nonunion advanced collapse – relevance of nonunion location

Vutescu, Emil Stefan; Jethanandani, Rishabh; Sneag, Darryl B.; Wolfe, Scott W.; Lee, Steve K.

doi:10.1177/1753193417739519

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…They underwent arthroscopic radial styloidectomy, which was useful in reducing radial wrist pain caused by SNAC [ 31 ]. However, radial styloidectomy of more than 3–4 mm might cause iatrogenic ligament injuries and carpal instability [ 32 , 33 ]. Recently, a cadaver study has shown that resection of more than 6 mm was associated with damage to radiocarpal ligaments [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic treatment of stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis

Shih

2023

J Orthop Surg Res

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Background This study was designed to analyze the clinical follow-up results (minimum of 2 years) in patients with stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis (Lichtman classification stage I–III) treated with arthroscopic osteosynthesis with autogenous bone graft. Methods We retrospectively recruited 44 consecutive patients with scaphoid fracture nonunion treated with arthroscopy-assisted percutaneous internal fixation with autogenous bone grafts from January 2010 to November 2019. We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean duration of 33 months (range 24–46 months). Clinical (i.e., visual analog scale pain score, grip strength, and range of motion), radiographic, and functional (Mayo Modified Wrist Score (MMWS)) outcomes at the final follow-up were compared with the preoperative assessments and analyzed in patients with different stages. Results We confirmed union in 39 of the 44 patients (88.6%) after a mean 15.4 weeks post-operatively according to clinical examinations and standard radiography. All clinical parameters improved significantly. For the MMWS, there were 25 excellent and 14 good results. Of the 44 patients, 40 (90.9%) returned to work or sports activities at their preinjury levels. Comparisons of the outcomes between patients in different stages of scaphoid nonunion revealed no significant difference in the aspect of union rate, VAS pain score, and functional score improvement. Conclusions Arthroscopic osteosynthesis with autogenous bone grafts is a reliable and minimally invasive method for achieving nonunion healing and improving clinical outcomes in stage I–III scaphoid nonunion. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic treatment of stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis

Shih

2023

J Orthop Surg Res

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“…However, contrary to our results, proximal scaphoid nonunion was associated with a higher mean score of global cartilage damage than waist or distal scaphoid nonunion. Another study also found that SNAC wrists with proximal scaphoid nonunion will probably have more chondral wear at the radial styloid and are more likely to require salvage procedures (Vutescu et al., 2018). Proximal scaphoid nonunion more likely allows dorsiflexion of the lunate if it is unrestrained by the distal scaphoid fragment, leading to dorsal intercalated segment instability.…”

Section: Discussionmentioning

confidence: 99%

“…When degenerative changes start, pain is caused by wear of articular cartilage rather than nonunion, so it is standard to perform salvage or arthroplasty surgery instead of an osteosynthesis procedure. Although for the first stage pain can be improved by resection of the radial styloid process and osteosynthesis of the scaphoid (Mayfield et al., 2019), in the second and third stages there are degenerative changes in the mid-carpal joint, so even if the osteosynthesis is successful, the pain may remain (Luchetti, 2018; Vutescu et al., 2018). Therefore, it is important to determine whether the arthritis has progressed to Stage 2 or not.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging analysis of the distribution of cartilage damage in scaphoid nonunion

Jung,

Kim,

Chung

et al. 2023

J Hand Surg Eur Vol

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This study aimed to evaluate the distribution and severity of cartilage damage using magnetic resonance imaging in patients with scaphoid nonunion without advanced wrist arthritis. We retrospectively analysed MRI of patients who underwent osteosynthesis for scaphoid nonunion. Cartilage damage was assessed in eight wrist regions using a modified Whole-Organ Magnetic Resonance Imaging Score. The frequencies of regions affected by any cartilage damage (Score ≥2.5) depicted on MRI were analysed. The study included 32 patients (31 men and one woman), with a mean age of 32 years (SD 11). The distal radioscaphoid (29/32), scaphotrapeziotrapezoid (STT) (22/32), proximal radioscaphoid (14/32) and scaphocapitate (11/32) joints were most commonly affected by degenerative cartilage damage. The STT and proximal radioscaphoid joint were especially likely to be involved in early-stage scaphoid nonunion advanced collapse. We recommend that surgeons should investigate the cartilage status of these joints during decision-making for scaphoid nonunion surgery. Level of evidence: III

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“…But, according to the study by Vutescu et al, radial styloidectomy should be performed with caution in cases with proximal pole scaphoid nonunion. Their results showed removal of part of the degenerated radial styloid could endanger the carpal extrinsic ligaments and cause carpal instability [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

Wang

Huang²,

Shih

2020

BMC Musculoskelet Disord

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Background There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint. Methods Between 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain. Results Nineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24–120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5o to 67.4o, wrist extension from 62.3o to 71.7o, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82o to 66o. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups. Conclusions Using arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.

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Radial styloidectomy for scaphoid nonunion advanced collapse – relevance of nonunion location

Abstract: III.

Cited by 12 publications

References 11 publications

Arthroscopic treatment of stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis

Arthroscopic treatment of stable nonunion, unstable nonunion, or nonunion of the scaphoid with early degenerative radioscaphoid arthritis

Magnetic resonance imaging analysis of the distribution of cartilage damage in scaphoid nonunion

Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoid nonunion

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