Bone-Grafting Techniques for Scaphoid Nonunion

Cooney, William P.

doi:10.1097/00130911-199709000-00002

Cited by 11 publications

(8 citation statements)

References 49 publications

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“…Despite the union rate ranging from 59% to 95% scaphoid nonunion is still a challenging problem especially in the presence of an avascular necrosis [3][4][5]. Vascularised bone grafts (VBG) seem a good alternative to achieve a successful result.…”

Section: Introductionmentioning

confidence: 99%

Scaphoid nonunion treated with vascularised bone graft from dorsal radius

Özalp

Öz

Kale

et al. 2015

Injury

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Section: Introductionmentioning

confidence: 99%

Scaphoid nonunion treated with vascularised bone graft from dorsal radius

Özalp

Öz

Kale

et al. 2015

Injury

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“…Bone grafting for scaphoid non-union is a widely accepted method, with a high percentage of healing, reaching 90% to 95% [6,9,18–22]. Historically, in 1928, Adams and Leonard [23] used cortical autograft placed between the 2 non-united fragments.…”

Section: Discussionmentioning

confidence: 99%

“…However, a small but quite important percentage of the scaphoid fractures lead to non-union and pseudarthrosis, as well as radio-scaphoid osteoarthritis and functional deficiency of the wrist [4,5]. A wide variety of methods for treating scaphoid non-union have been described, including surgical techniques (drilling, bone grafting, internal fixation), non-invasive techniques (electrostimulation), or a combination of these methods [6–14]. In the past, the Matti-Russe technique was a widely applied method using iliac autologous bone graft [5,15–17].…”

Section: Introductionmentioning

confidence: 99%

A modified matti-russe technique for the treatment of scaphoid waist non-union and pseudarthrosis

et al. 2011

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SummaryBackgroundThe aim of this study was to analyze the long-term results of a modified Matti-Russe technique for the treatment of scaphoid non-union and pseudarthrosis. The modification was based on the use of bone graft taken from the ipsilateral distal radius, rather than from the iliac crest, as originally described.Material/MethodsBetween 1987 and 2000, 23 consequent male patients with scaphoid waist non-union or pseudarthrosis underwent surgery by a modified Matti-Russe technique. During the 5-year follow-up, patient evaluation was based on radiological findings and the Green & O’Brien scoring system.ResultsAnatomy was restored and healing of the non-union was achieved in 21 (91.3%) patients. The other 2 patients failed to achieve union and underwent the same operation a second time, which was successful. According to the Green & O’Brien scoring system, 82.6% (19/23) of patients showed excellent results and 17.4% (4/23) showed good results at 2-year follow-up. At 5-year follow-up, 73.9% of patients (19/23) had excellent results and 26.0% (4/23) had good results. No early postoperative complications developed. Two patients demonstrated mild radiological radio-scaphoid arthritis at 2.5 years postoperatively. All patients returned to previous levels of activity.ConclusionsThe standard Matti-Russe technique is an old but reliable and inexpensive method for the treatment of long-standing or neglected scaphoid non-unions or pseudarthroses. The modification of this established method, based on use of the distal radius as a donor site, reduces operative time, can be performed through a single approach, does not show donor site morbidity, and allows the use of regional anaesthesia.

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“…Immer noch werden viele Frakturen primär übersehen und bei persistierenden Beschwerden erst im Stadium der Pseudarthrose diagnostiziert [11,15]. Frakturen und Pseudarthrosen im proximalen 1/3 des Skaphoids sind besonders problematisch, da das proximale Fragment aufgrund seiner geringen Größe schwer zu fixieren ist und die Frakturen als instabil gelten [3,16]. Die Durchblutung des Skaphoids erfolgt zu 70-80% von distal über Äste aus der A. radialis [9].…”

Section: Zusammenfassungunclassified

“…Frakturen im proximalen Drittel des Kahnbeins sind prinzipiell als instabil anzusehen und bedürfen einer operativen Versorgung [3]. Pseudarthrosen in diesem Bereich sind häufig minderdurchblutet und deshalb als prognostisch ungünstig zu werten [9].…”

Section: Diskussionunclassified

Versorgung proximaler Kahnbeinpseudarthrosen und -frakturen mit der Mini-Herbert-Schraube über einen dorsalen Zugang

et al. 2001

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32 patients, aged 16 to 49 years, were treated by osteosynthesis using the Herbert mini screw. The indications were five fractures (type B3, Herbert classification), two delayed unions (type C) and 25 nonunions (type D1 to D3, Filan and Herbert classification). Six patients received no bone grafts, 19 received cancellous bone graft from the radius. An interpositional iliac crest bone graft was used in four, and a vascularized bone graft from the distal radius in three cases respectively. The average postoperative immobilisation in a forearm splint was nine weeks. 26 patients could be recruited for clinical follow-up at an average of 14.5 months. The radiological results were assessed in 30 cases (94%). Bony consolidation was achieved in 26 cases (100% of the fractures, 84% of the nonunions). In three cases a loosening of the screw, and in three further cases a dislocation into the radiocarpal joint were observed. A humpback deformity was present in four cases. Three patients showed a persisting nonunion, one patient a fibrous union. Early degenerative changes of the radiocarpal joint were observed in six cases. The clinical follow up examination showed an average grip strength of 91% (JAMAR II), 94% for the three finger, and 95% for the pinch grip compared to the contralateral side. The mean postoperative pain score on the visual analog scale was one for resting conditions, eleven for motion and 33 under stress. The range of motion was 79% of the opposite side for extension/flexion and 83% for radial/ulnar deviation. The average DASH-score reached 15 points. The Herbert mini screw has proven to be a reliable implant for reconstruction of proximal pole fractures and nonunions of the scaphoid.

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Bone-Grafting Techniques for Scaphoid Nonunion

Cited by 11 publications

References 49 publications

Scaphoid nonunion treated with vascularised bone graft from dorsal radius

Scaphoid nonunion treated with vascularised bone graft from dorsal radius

A modified matti-russe technique for the treatment of scaphoid waist non-union and pseudarthrosis

Versorgung proximaler Kahnbeinpseudarthrosen und -frakturen mit der Mini-Herbert-Schraube über einen dorsalen Zugang

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