Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Guo, Yang; Ma, Wei; Tong, Dedi; Liu, Kun; Yin, Yuehan; Yang, Chi

doi:10.1177/1753193420944546

Cited by 16 publications

(9 citation statements)

References 30 publications

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“…One may imagine that placing two screws is more challenging than placing a single screw centrally. The robotic-assisted scaphoid double-screw insertion technique, as we described previously, may provide a practical solution to reduce surgery time and improve guide wire insertion accuracy (44). This novel technique has not been accepted in treating displaced nonunions with open debridement and bone grafting.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases

Yao²,

Guo³

2023

Front. Surg.

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PurposeThis study reports the clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions.Patients and methodsThis study was a retrospective survey. From January 2018 to December 2019, 21 patients with displaced scaphoid fractures underwent open debridement and two headless compression screw fixation with bone grafting. The preoperative and postoperative lateral intrascaphoid angle (LISA) and scapholunate angle (SLA) were recorded. Preoperative and postoperative grip strength (% of the healthy side), active range of motion (AROM), visual analogue scale (VAS), and patient-rated wrist evaluation (PRWE) scores at the final follow-up were obtained for all patients for comparison.ResultsPatients were treated for an average of 38.3 months (range 12–250) after the injury. The average time of postoperative follow-up was 30.5 months (range 24–48). All fractures achieved union at a mean of 2.7 months (range 2–4) after surgery, and 14 scaphoids of 21 patients (66.7%) healed by 8 weeks. CT scans showed no evidence of cortical penetration of either screw in all patients. There was a statistically significant improvement in AROM, grip strength, and PRWE. No complications occurred in this study, and all patients returned to work.ConclusionThis study indicates that double-screw fixation with bone grafting is an effective technique for treating displaced scaphoid nonunions.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases

Yao²,

Guo³

2023

Front. Surg.

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“…3,5,6 Nonunions can occur even if there was timely intervention with cast immobilization. 5,7,8 There have been various surgical techniques reported in the literature, [9][10][11][12][13][14] but the consensus for optimal treatment recommendation for scaphoid nonunions remains debatable. Non-vascularized bone grafts with internal fixation are reported to have an 88% union rate for scaphoid nonunion, 15 however open surgery theoretically does additional damage to important structures such as the joint capsule, ligaments, and potentially threatens the already tenuous blood supply.…”

Section: Introductionmentioning

confidence: 99%

“…[22][23][24] With the advent of robotic navigation systems in hand surgery, the overall accuracy, efficacy, and safety of percutaneous fixation of scaphoid fractures have greatly improved. 9,[25][26][27][28] As such, we propose a novel MIS surgical technique of ABG combined with robot-assisted fixation for the treatment of scaphoid non-unions. With the use of three-dimensional (3D) intraoperative real-time image navigation, percutaneous scaphoid fixation becomes precise and easy to perform.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Bone Grafting and Robot‐assisted Fixation for Scaphoid Nonunion

Yi,

Lim,

Chen

et al. 2023

Orthopaedic Surgery

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ObjectivesScaphoid nonunion remains a challenging problem to manage with no general consensus on its treatment recommendations. We propose a novel minimally invasive (MIS) technique of arthroscopic bone grafting (ABG) with robot‐assisted fixation for the treatment of scaphoid nonunions.MethodsPatients with radiographically proven scaphoid nonunion treated by this novel surgical technique were included. Following arthroscopic debridement and iliac crest bone grafting, the scaphoid was fixed percutaneously using either multiple Kirschner (K)‐wires or a headless compression screw using a robotic navigation system.ResultsSix male patients with an average age of 29.2 years were enrolled. Four patients had scaphoid waist fractures, and the other two were proximal pole fractures. During wrist arthroscopy, punctate bleeding of the proximal scaphoid fragment was observed in four out of the six patients. Half of the patients were fixed using a headless compression screw and the other half using multiple K‐wires. All the guidewires were placed with a single‐attempt using the robotic navigation system. Postoperatively, all the scaphoid fractures had complete radiographic union by 16 weeks. At a mean follow‐up of 18.3 months, there were significant improvements in wrist range of motion, grip strength, and patient‐rated outcomes. No intraoperative or early postoperative complications were encountered in any of our patients.ConclusionArthroscopic bone grafting with robot‐assisted fixation is a feasible and promising therapeutic option for scaphoid nonunions, regardless of the vascularity of the proximal pole fragment. This novel technique allows for anatomic restoration of the scaphoid alignment and accurate, targeted placement of implants into the scaphoid nonunion site within a single‐attempt using a robotic navigation system.

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“…Robot-assisted techniques have also been effectively used in the field of trauma orthopaedics for the post-operative rehabilitation of femoral neck fracture, pelvic fracture, and distal radius fracture [6][7][8]. Moreover, the use of robot-assisted technology in scaphoid fracture and nonunion has achieved good clinical results [3,9]. This study retrospectively analyzed the operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy of robot-assisted fixation and traditional percutaneous freehand fixation in the treatment of non-displaced scaphoid fractures.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study

Xiao

Wei

Zhu

et al. 2022

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to assess the efficiency, safety, and accuracy of cannulated screw fixation using a robot-assisted method compared with a traditional percutaneous freehand method. Methods This retrospective clinical study included 18 patients with scaphoid fracture who underwent cannulated screw fixation by robot-assisted technique or traditional percutaneous freehand technique from June 2018 to June 2020. All patients were divided into the robot-assisted group (9 patients) or the traditional surgery group (9 patients). The operation time, blood loss, number of intra-operative fluoroscopies, fracture healing time, Mayo wrist function score, and screw implantation accuracy were recorded in the two groups. Results The average age of the robot-assisted group was 37.9 ± 10.6 years (with a range of 30 to 52 years), there were eight males and one female, and there were six cases of scaphoid fracture on the right side and three on the left side. The average pre-operative time was 2.8 ± 0.7 days (ranging from 1 to 3 days). The average age of the traditional surgery group was 31.6 ± 6.8 years (with a range of 20 to 45 years), there were eight males and one female, and there were five cases of scaphoid fracture on the right side and four on the left side. The average pre-operative time was 2.1 ± 0.8 days (with a range of 2 to 4 days). The number of intra-operative fluoroscopies was 24.4 ± 3.5 in the traditional surgery group, whereas it was only 10.1 ± 1.9 in the robot-assisted group, which was significantly lower (P < 0.05). The average operation time of the traditional operation group was 48.4 ± 12.2 min, and that of the robot-assisted group was 32.6 ± 4.2 minutes, which was significantly shorter (P < 0.05). The angles between the actual screw position and the central axis of the scaphoid on both the coronal and sagittal post-operative CT images were 8.3° ± 2.3° and 8.8° ± 1.6° for the traditional operation group and 3.8° ± 0.8° and 4.3° ± 1.2° for the robot-assisted group, so the accuracy of the robot-assisted group was significantly higher (P < 0.05). There were no significant differences between the two groups in wrist function recovery or fracture healing time. Conclusion Robot-assisted treatment of scaphoid fracture is more accurate than traditional freehand technology, with shorter operation time and fewer intra-operative fluoroscopies. There is no difference between the two surgical techniques in intra-operative bleeding, post-operative fracture healing, or functional recovery. Robot-assisted surgery is a safe, effective, and accurate method for treating scaphoid fracture.

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Robot-assisted double screw fixation of minimally displaced scaphoid waist fracture nonunions or delayed unions without bone graft

Cited by 16 publications

References 30 publications

Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases

Clinical outcomes of double-screw fixation with bone grafting for displaced scaphoid nonunions: A series of 21 cases

Arthroscopic Bone Grafting and Robot‐assisted Fixation for Scaphoid Nonunion

Robot-assisted vs traditional percutaneous freehand for the scaphoid fracture treatment: a retrospective study

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