A new vascularized bone graft for scaphoid nonunion

Zaidemberg, Carlos; Siebert, John W.; Angrigiani, Claudio

doi:10.1016/0363-5023(91)90017-6

Cited by 467 publications

(356 citation statements)

References 8 publications

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“…Semptomlu olan skafoid psödoartrozlarının skafoid kollapsına ve el bilek artrozuna neden olabileceği bildirilmiştir. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Bununla beraber birçok çalışma skafoid psödoartrozu sonrasında el bileği artrozuna neden olacak prognostik faktörleri belirleyememiştir. [5,7,10] Semptomlu skafoid psödoartoz olgularında, kalıcı sakatlıkları engellemek için tedavi büyük önem kazanmaktadır.…”

Section: Discussionunclassified

“…Literatürde vasküler pediküllü greft, otolog kemik greftleri ve çeşitli fiksasyon yöntemleri ile başarılı sonuçlar bildirilmiştir. [9][10][11][12][13][14][15][16] Çalışmamızda skafoid psödoartroz olgularında uyguladığımız otolog iliak trikortikal kemik grefti ve başsız tam yivli kompresif kanüle vida kombinasyonu cerrahi tedavisinin radyolojik ve klinik sonuçları ile kaynamaya etki eden faktörleri araştırdık. Hastalar ameliyat öncesi standart olarak çekilen el bileği ön-arka, yan ve ulnar deviasyonda ön-arka grafileri ile değerlendi-rildi.…”

Section: Introductionunclassified

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The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion

Özdemir¹,

Çiçekli²,

Akgül³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Bu çalışmada skafoid psödoartroz tedavisinde uyguladığımız debridman, otolog iliak kanat kemik grefti ile titanyum başsız kanüle kompresyon vidası kombinasyonunun radyolojik ve klinik sonuçlarını sunmaktır. GEREÇ VE YÖNTEM:2009-2012 tarihleri arasında skafoid psödoartroz tanısı ile iliak kanat kemik grefti ve başsız kanüle vida ile ameliyat edilen ve en az 12 aylık takibi olan 24 hastanın 24 el bileği geriye dönük olarak incelendi. Psödoartroz standart çekilen grafilerde kırık zamanından sekiz hafta geçmesine rağmen kaynama bulgusu olmaması olarak belirlendi. Skafoid kırıkları Herbert sınıflamasına ve anatomik yerleşime göre sınıflandı. Hastalarının klinik değerlendirilmesinde Mayo el bilek skorlaması kullanıldı. BULGULAR:Herbert sınıflamasına göre 20 hasta D1 ve dört hasta D2, anatomik sınıflamaya göre bir hasta distal, altı hasta proksimal ve 17 hasta gövde kırığı olarak belirlendi. İki hasta haricinde tüm hastalarda tam kaynama ortalama 9.5 (6 ila 15 hafta) haftada sağlandı. Son kontrollerde skafolunat ve radiolunat açıları sırası ile ortalama 32° (39° ile 50°) ve 7° (4° ile 10°) idi. İstatistiksel olarak kaynama ve psödoartroz süreleri arasında bağlantı tespit edildi (p=0.003). Kırık hattı proksimal bölgeye yaklaştıkça kaynama süresi uzamakta idi (p=0.004). Mayo el bilek skoru ortalama 86 (80-95) olarak belirlendi. SONUÇ:Skafoid psödoartroz tedavisinde volar yaklaşımla iliak kanattan alınan trikortikal otogreft ve başsız kanüle kompresyon vidası kombinasyonu, başarılı kaynama ve fonksiyonel sonuç veren bir yöntemdir.Anahtar sözcükler: Başsız kompresyon vidası; el bileği volar yaklaşım; otolog iliak kemik grefti; skafoid kaynamama; skafoid psödoartroz. GİRİŞSkafoid kırıkları karpal kemik kırıkları içinde en sık rastlanan kırıklardır ve ortalama görülme sıklığı 23-43/100000 olarak bildirilmektedir.[1] Skafoid kırıkları, sıklıkla el bileğinin hiperekstansiyon ve radial deviasyonda iken aksiyel sonrasında meydana gelmektedir.[2] Tanıda kullanılan standart radyografi incelemelerinde skafoid kırık hattının net olarak belirlenememesi nedeni ile sıklıkla geç tanı konulmakta veya gözden kaçırılmaktadır. Kırık tanısı konulduktan sonraki ilk tedavi yöntemi, deplase olmamış ve stabil kırıklarda konservatif tedavi yöntemi olan alçı uygulamasıdır. [3,4] Skafoid psödoartrozu; tedavi edilmeyen olgularda, tanısı konulamayan ve konservatif tedaviye rağmen iyileşme meydana gelmeyen hastalarda gelişir.Literatürde kırık oluşumundan altı hafta sonra tanı konulan ve sekiz haftalık konservatif tedaviye rağmen radyolojik olarak kaynama bulgusu görülmeyen skafoid kırıklarında psödoart-roz gelişme riski bildirilmektedir. [5][6][7] Psödoartroz veya yanlış kaynama olgularını en aza indirmek için cerrahi endikasyonlar; deplase kırıklar, parçalı kırıklar, proksimal kutup yerleşimli kı-rıklar, tedavisi gecikmiş kırıklar, hasta uyumsuzluğu ve açısal sorunlar olarak bildirilmiştir.[6-8] Psödoartroz gelişme insidan-

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Section: Discussionunclassified

Section: Introductionunclassified

The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion

Özdemir¹,

Çiçekli²,

Akgül³

et al. 2014

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

show abstract

“…However, this article is focused upon the difficult subset of scaphoid non-unions which have (1) displacement, (2) comminution and (3) cavitary defects with bone shortening, flexion, humpback deformity and DISI. Patients with avascular necrosis were not included in this difficult subset as vascularised bone grafts would be our first treatment in these patients [38]. Technical difficulties have been previously noted by many authors in the insertion of compression screws for scaphoid non-unions, especially when there is a cavitary or humpback deformity of the remaining un-united native scaphoid [1,16,36].…”

Section: Discussionmentioning

confidence: 99%

Cancellous Bone Graft and Kirschner Wire Fixation as a Treatment for Cavitary-Type Scaphoid Nonunions Exhibiting DISI

Kirkham

Millar

2011

Hand (New York, N,Y.)

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Background Cavitary-type scaphoid non-unions represent one of the most difficult treatment challenges amongst all scaphoid non-unions as they exhibit bone loss, scaphoid shortening, flexion ('humpback') deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. Our technique and its rationale are presented in the largestto-date series on cavitary scaphoid non-unions exhibiting DISI. Methods Our technique for treatment of these cavitary nonunions is presented through a series of 27 patients. Results Union was achieved in (26/27) 96% of cases, with no complications. Carpal mechanics was restored, with an average carpal height index of 1.52±0.06, and an average scapholunate angle was 46±9°. Average follow-up was 2.2 years. Conclusion In this subset of patients, we believe this technique is less technically demanding than the use of either cortico-cancellous grafts or various compression screws. Our success equals or betters that of other published techniques, with all patients enjoying a full return to work, even in occupations demanding heavy labour. We believe that scaphoid union, coupled with the often difficult restoration of carpal height and intra-carpal angles, has produced very good functional outcomes in the management of these challenging cases.

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“…There were 21 males and 7 females, and average age was 32 years. We used vascularized bone grafts from three different donor sites: the extensor fourth and fifth compartmental distal radius 29,31,32,40 in 8 patients, the first and second intercompartmental distal radius 41,42 in 12 patients, and the second dorsal metacarpal neck [43][44][45] in 8 patients. Selection of the donor site was according to the surgeon's preference (►Figs.…”

Section: Methodsmentioning

confidence: 99%

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

et al. 2016

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Previous literatures described various methods of treatment for Kienböck disease depending on the patient characteristics, the severity of the symptom, and radiological staging. 1-8 Treatment options range from conservative measurements to surgical interventions. 9-12 Several authors advocated a biomechanical approach to reduce load transmission on the necrotic lunate, [13][14][15][16][17][18][19] and good clinical results have been reported in joint leveling procedures such as radial shortening or ulnar lengthening 20-22 and in radial or ulnar wedge osteotomy. 23,24 Hori et al 25 introduced a biological approach of revascularization for necrotic bones based on their experimental results. Since then, there have been several donor sites available for vascularized bone graft in the treatment of AbstractPurpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients. Average age was 32 years, and radiological grading according to Lichtman classification was stage 2 in 8 patients, stage 3A in 10 patients, and stage 3B in 10 patients. Temporary pinning fixing the midcarpal joint was conducted for 10 weeks postoperatively. Results Follow-up periods averaged 70 months. Pain reduced in 27 patients, and visual analog scale for pain of pre-and postoperative level averaged 59 and 18. Range of wrist flexion and extension motion improved from 87 to 117 degrees, and average grip strength improved from 21 kg preoperatively to 33 kg postoperatively. Carpal height ratio had almost no change from 0.52 to 0.53. Fragmentation of necrotic bone healed in 7 of the 14 cases. Comparative analyses of functional and radiological outcomes between three donor sites found no significant difference. Conclusion Three different vascularized bone grafts from the dorsal wrist and hand area demonstrated favorable and comparable functional outcomes. It was technically important to elevate vascular bundle with surrounding retinaculum or fascia, to include sufficient periosteum, and to insert the vascularized bone as the cortex aligned longitudinally.

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A new vascularized bone graft for scaphoid nonunion

Cited by 467 publications

References 8 publications

The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion

The results of autologous bone graft and titanium headless cannulated compression screw for treatment of scaphoid nonunion

Cancellous Bone Graft and Kirschner Wire Fixation as a Treatment for Cavitary-Type Scaphoid Nonunions Exhibiting DISI

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

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