Treatment of Avascular Proximal Pole Scaphoid Nonunions With Vascularized Distal Radius Bone Grafting

Lim, Tae Kang; Kim, Hyo Kon; Koh, Kyoung Hwan; Lee, Hyun Il; Woo, Sung Jong; Park, Min Jong

doi:10.1016/j.jhsa.2013.07.025

Cited by 38 publications

(30 citation statements)

References 21 publications

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“…12 Similarly, Lim et al also suggested that fracture fragment size may influence outcomes after scaphoid nonunion surgery. 13 Despite traditional believe that blood supply is linked to risk for nonunion, newer evidence suggests proximal pole vascularity may not play as critical a role in ability to progress to union after nonunion ORIF as has classically been thought. 14 Surgical factors have also been investigated for their role in scaphoid nonunion.…”

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confidence: 99%

Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

et al. 2020

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Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

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confidence: 99%

Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

et al. 2020

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“…Several bone grafts options from different donor sites have been reported, all with a high success rate. [11][12][13][14] However, this type of surgery not only increases the morbidity of the procedure, but also entails greater technical skills, greater surgical training, an increased economic cost and longer operating room time, all of which are unnecessary factors in patients with a vital proximal pole, without previous surgical failure and with a sufficient proximal pole size to be fixed by a cannulated screw.…”

Section: Discussionmentioning

confidence: 99%

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

et al. 2019

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Objective To report the consolidation rate and the results of a series of 22 patients with metaphyseal core decompression of the distal radius and an antegrade compression screw. Methods We present a prospective series of patients with scaphoid proximal pole nonunion in whom the presence of intraoperative bleeding was confirmed in both fragments. Patients with displacement, degenerative changes, fragmentation of the proximal pole, cavitation of the focus, loss of height, and necrosis, as well as those with carpal instability, were excluded. The patients were evaluated with X-rays and computed tomography to evaluate their consolidation; their mobility and fist strength were recorded and an analog visual scale (VAS) of pain at rest, pain in activity, subjective functional status, and DASH questionnaire were completed. Results Of the 23 patients, 21 accomplished union. The average follow-up was 19 months and the average final range of motion was flexion 86%, extension 85%, radial deviation 79%, ulnar deviation 84%, and grip strength 84%. The average VAS for pain at rest was 1 point, the average VAS for activity pain was 2 points, the average VAS for function was 9 points, and the average DASH score was 8. Conclusions Using this simple and reliable technique, we obtained 91% union and very good functional results. Metaphyseal core decompression of the distal radius associated with an antegrade scaphoid screw is a reasonable and effective option for the treatment of proximal pole scaphoid nonunions without avascular necrosis in carefully selected patients. Level of Evidence This is Level IV study.

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“…10,11 Several techniques have been described that address the challenges associated with proximal pole scaphoid fractures. [2][3][4] Concerns with any technique involving fixation of the proximal scaphoid pole are the concomitant iatrogenic disruption of the scapholunate ligament and resultant dorsal intercalated segmental instability deformity. 12 Suture anchor fixation of proximal pole fragments measuring less than 20% of scaphoid area resulted in successful union in 10 of 11 patients in a report by Kamrani et al 5 ; however, the authors point out the potential for irritation and impaired motion caused by the suture knot in the radioscaphoid joint.…”

Section: Discussionmentioning

confidence: 99%

“…Calculations of the size of the proximal pole fragment relative to the total scaphoid were performed according to a previously published technique for estimating cross-sectional area. 3 A posterior-anterior scaphoid view radiograph was obtained with the wrist in ulnar deviation and flat on the cassette. We used our institution's picture archiving and communication system to create a freehand polygonal region of interest area calculation of both the proximal fragment and total scaphoid (Sectra Workstation IDS7, Sectra AB, Linköping, Sweden) (►Fig.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft

et al. 2018

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Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity. The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm. Patients with proximal pole scaphoid fragments comprising less than 20% of the entire scaphoid were included. Fixation was accomplished from a dorsal approach with a micro headless compression screw and distal radius bone graft. Six patients were included. Average follow-up was 44 months (range, 11-92). Mean proximal pole fragment size was 14% (range, 9-18%) of the entire scaphoid. The mean immobilization time was 6 weeks, time-to-union of 6 weeks, and final flexion/extension arc of 88°/87°. All patients had a successful union, and no patient had deterioration in range of motion, avascular necrosis, or fragmentation of the proximal pole. Small diameter screws with a maximal thread diameter of ≤ 2.8 mm can be used to fix the union of proximal pole acute scaphoid fractures comprising less than 20% of the total area with good success. Therapeutic case series, Level IV.

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Treatment of Avascular Proximal Pole Scaphoid Nonunions With Vascularized Distal Radius Bone Grafting

Cited by 38 publications

References 21 publications

Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

Metaphyseal Core Decompression and Anterograde Fixation for Scaphoid Proximal Pole Fracture Nonunion without Avascular Necrosis

Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft

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