First Experiences With a New Adjustable Plate for Osteosynthesis of Scaphoid Nonunions

Leixnering, M.; Pezzei, Ch.; Weninger, Patrick; Mayer, Michaël; Bogner, Robert; Lederer, Stefan; Schauer, Josef; Figl, Markus

doi:10.1097/ta.0b013e3181f65721

Cited by 44 publications

(31 citation statements)

References 21 publications

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“…Leixnering et al treated 6 patients with scaphoid nonunions who had previously undergone screw fixation with plate osteosynthesis and reported 100% union rate at an average of 5 months. 32 The most significant weakness of our study was the small sample size, limiting the power of our results. The retrospective nature and lack of controls also potentially introduces bias.…”

Section: Discussionmentioning

confidence: 92%

The Use of BMP-2 and Screw Exchange in the Treatment of Scaphoid Fracture Non-Union

Ablove

Abrams²

2015

Hand Surg.

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Scaphoid non-union, particularly following internal fixation, is a vexing problem. A retrospective review was conducted analysing the outcome of 4 patients who failed initial open reduction and internal fixation of scaphoid fractures. Three fractures were located in the waist and the fourth in the proximal pole. All patients underwent screw exchange and Bone Morphogenic Protein (BMP)-2 sponge placement with no additional bone grafting. Patients were immobilised for 4 weeks and followed with serial radiographs in all cases and CT scans in 3 cases. All patients demonstrated evidence of bony union at an average of 53 days from surgery and ultimately returned to pain-free full activity. There were no complications. BMP-2 and screw exchange yielded a 100% union rate in patients with established scaphoid non-union. While this retrospective study represents a small number of patients and clearly requires further investigation, it presents a promising technique for managing a difficult clinical problem.

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Section: Discussionmentioning

confidence: 92%

The Use of BMP-2 and Screw Exchange in the Treatment of Scaphoid Fracture Non-Union

Ablove

Abrams²

2015

Hand Surg.

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“…14 However, poorer outcomes have been reported with grip strength of 30 kg, or only 55% of the unaffected side. 15 Clinical symptoms have included clicking, cold intolerance, or aching 9 or pain on open palm push-ups. 14 We had one case of radioscaphoid arthritis-mainly affecting the radial styloid.…”

Section: Discussionmentioning

confidence: 99%

“…7 The plate can press on corticocancellous graft and prevent it from displacing. 8 It has been used in nonunions, 9 comminuted fracutures, 10 and with vascularized grafts. 11 As this is a relatively new technique, small series in the literature have been published.…”

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confidence: 99%

Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

et al. 2020

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Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13–46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0–42) and mean PRWE was 11 (range 0–54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.

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“…Thirty-four cases of volar plate fixation of scaphoid nonunion with vascularized or iliac crest bone graft have been described among Dodds et al, Ghoneim, and Leixnering et al Those authors report two failed union among these 34 cases. 5,12,13 For biomechanical reasons alone, the authors propose that locking plate fixation should be considered at least equivalent to screw fixation for scaphoid nonunion. Based on the superior performance of locking plates in simulated osteoporotic bone, and other clinical considerations, the authors believe that locking plate fixation merits consideration in cases of scaphoid nonunion with segmental defect.…”

Section: Discussionmentioning

confidence: 99%

A Biomechanical Comparison of Screw and Plate Fixations for Scaphoid Fractures

et al. 2017

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Headless screw fixation is the current gold standard of surgical repair for scaphoid fractures. However, maintaining reduction of certain types of scaphoid fractures is challenging with a compression screw. Plate fixation may offer superior fixation in some scaphoid fractures, particularly those with comminution, nonunion, segmental bony defects, and osteopenic or osteoporotic bone. This study questions whether method of fixation is a determinant in load to failure in segmental scaphoid fractures, and whether any fixation provides a greater mechanical advantage in simulated normal versus osteoporotic bone. Polyurethane models were fashioned to simulate scaphoids with 3-mm segmental defects. Defects were bridged by one of three constructs: a locking plate, a nonlocking plate, or a headless compression screw. Three models for each fixation construct were tested for both simulated normal and osteoporotic bone density. Load to failure was recorded as the load at which the 3-mm segmental defect was closed. Gap closure occurred in all trials. In simulated normal bone, there were no statistically significant differences in load to failure between fixation methods. In simulated osteoporotic bone, the locking plate had a 28% greater load to failure as compared with screw fixation. While biomechanical testing shows that plate and screw fixations are equivalent in normal density bone for fixation of a segmental scaphoid defect, locking plates are superior to screw fixation in simulated osteoporotic bone models. Plate fixation may provide superior fixation for complex scaphoid fractures, particularly in osteopenic bone.

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First Experiences With a New Adjustable Plate for Osteosynthesis of Scaphoid Nonunions

Cited by 44 publications

References 21 publications

The Use of BMP-2 and Screw Exchange in the Treatment of Scaphoid Fracture Non-Union

The Use of BMP-2 and Screw Exchange in the Treatment of Scaphoid Fracture Non-Union

Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

A Biomechanical Comparison of Screw and Plate Fixations for Scaphoid Fractures

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