Scaphoid Nonunion

Waitayawinyu, Thanapong; McCallister, Wren V.; Nemechek, Nicholas M.; Trumble, Thomas E.

doi:10.5435/00124635-200705000-00009

Cited by 24 publications

(33 citation statements)

References 51 publications

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“…However, the algorithm described above seems to be reasonable and should be considered in treatment planning (4). The advantage of our material is in a relatively shortlasting nonunion (a mean of 10 months).…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of our material is in a relatively shortlasting nonunion (a mean of 10 months). It is suggested that if bone consolidation is not achieved within six months, operative treatment should be considered (3,4,31).…”

Section: Discussionmentioning

confidence: 99%

“…Because of this, and because of the specific vascularity of scaphoid bone (the primary arterial supply enters the bone from distal pole), nonunion of the scaphoid is quite common, reaching a rate of up to 25-45% in proximal pole fracture (2,3). Operative treatment of scaphoid fracture decreases the rate of the late nonunion (4,5). Nonunion of the scaphoid causes not only pain but also causes carpal instability, diminishing the range of motion and increasing arthritic changes with time (6).…”

mentioning

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).…”

mentioning

confidence: 99%

“…Delayed union or nonunion is an indication for surgery (3,4,8). Classical management includes debridement of the nonunion, followed by osteosynthesis with K-wires, Herbert screws or headless canullated screws with or without bone grafting (4,(9)(10)(11)(12)(13). Some authors choose the method of treatment based on the site of the facture and vascularity of the bone fragments (4).…”

mentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%