Herbert Screw Fixation for Scaphoid Nonunions; An Analysis of Factors Influencing Outcome

Inoue, Goro; Shionoya, Kaori; Kuwahata, Yoshio

doi:10.1097/00003086-199710000-00019

Cited by 62 publications

(48 citation statements)

References 16 publications

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“…While the cast treatment of unstable scaphoid fractures results in an onunion rate as high as 50% (14), even stable fractures cannot be reliably treated by plaster immobilization with nonunions as high as 22% (13). The treatment of scaphoid nonunions is ac hallenge even for the most skilled hand surgeon with a22-50% failurerate reported for the open surgical repair of scaphoid nonunions with bone graft (15,16,17,18). These treatments require long healing time (often greater than 6months), and often result in poor functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Slade

Gillon

2008

Scand J Surg

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the purpose of this paper is to retrospectively review 234 consecutive cases of scaphoid fractures and nonunions treated using arthroscopy with the dorsal percutaneous implantation of ah eadless compression screw for healing and complications. solid union of fracture is determined by ct scan. we identified 126 acute injuries, including 65 proximal pole fractures; 67 grossly displaced fractures; 12 trans-scaphoid perilunate dislocations including four trans-scaphoid trans-capitate fractures; and ten combined scaphoid and distal radius fractures. 108 scaphoid nonunions were identified. 98 were correctly aligned and ten had ah umpback deformity which was correctable using arthroscopic assisted reduction techniques at the time of surgery.8 2p resented with af racture gap 2mm or greater requiring percutaneous bone grafting. 12 cases of avascular necrosis (avn) were identified by mRi. 20 nonunions had surgery performed at other institutions. the mean time to surgery for the nonunions was 20 months.99% union rate of acute scaphoid fractures was obtained by 12 weeks, as determined by ct scan. twoc omplications were identified (3%). one case of delayed healing was identified. this delayed union was treated with percutaneous bone grafting and continued on to heal uneventfully.the other complication was acase of volar trans-scaphoid peri-lunate dislocation. while the fracture healed, the patient developed at raumatic dislocation requiring ac apitate-lunate arthrodesis. tr eatment of scaphoid nonunions resulted in ten cases of delayed healing, which were treated with repeat percutaneous bone grafting. this represented a9 %c omplication rate. of the ten cases of delayed unions that were re-bone grafted, four failed to heal by nine months. this resulted in a 96% union rate of our nonunion group by nine months. when acute fracture healing was compared to nonunions the average healing of acute fractures as determined by ct scanning measuring trabecular bridging was 12 weeks, while the average healing of nonunions was 22 weeks. we conclude that the dorsal percutaneous treatment of scaphoid fractures and nonunions using arthroscopy is safe and effective. ct scans to evaluate scaphoid healing by measuring trabecular bridging at the fracture site was determined to be an excellent modality to evaluate scaphoid healing. while not witnessed in this series, the potential for complications requires proper training.

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Section: Introductionmentioning

confidence: 99%

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Slade

Gillon

2008

Scand J Surg

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“…The failure occurred in nonunions localised in proximal pole, with associated avascular necrosis and long lasting. Authors did not note the influence of humpback deformity of the scaphoid on final results, however, presence of arthritis and long postoperative immobilisation worsen the results (31).…”

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%

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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“…[9] Araştırmalarda skafoid proksimalinin distaline göre daha zayıf kanlandığı, proksimal kırıklarda kaynama oranlarının düşük olduğu gösterilmiştir. [5,10] Prognozu etkileyen faktörleri Inoue ve ark., [11] (i) proksimal fragmanın vaskülaritesi, (ii) fragmanın instabilitesi, (iii) cerrahide gecikme ve (iv) proksimal kırık şeklinde sıralamışlardır. Ayrıca uzun süreli alçı tespiti, cerrahide beş yılın üzerinde gecikme ve osteoartriti de kötü prognostik faktörler olarak belirtmişlerdir.…”

Section: Discussionunclassified

Is nonvascularized autografting in the proximal scaphoid nonunions ineffective?

Pişkin

Çıraklı

Erdoğan

et al. 2014

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada nonvaskülarize kemik grefti ve vida tespiti ile proksimal skafoidin kaynamama tedavisinin sonuçları değerlendirildi. Hastalar ve yöntemler: Kliniğimizde proksimal bölge skafoid kaynamaması nedeniyle ameliyat edilen ve en az bir yıl süre ile takibi yapılan 13 hasta değerlendirildi. El bilek hareketleri standart gonyometre ve kas gücü el dinamometresi ile ölçüldü. Kaynamama radyolojik olarak Schernberg sınıflamasına göre, fonksiyonel değerlendir-me ise Herbert-Fisher derecelendirme sistemi ve Mayo Kliniği modifiye el bileği skorlama sistemine göre sınıf-landırıldı. Bulgular: Ortalama takip süresi 14 ay (dağılım, 12-40 ay) idi. On üç hastadan sekizinde (%61.5) tam kaynama gözlendi. Ortalama kaynama süresi 16 hafta (dağılım, 12-40) idi. Tam kaynama olanların el bileği hareketlerinde sağlam ele göre %10'dan fazla fonksiyon kaybı gözlenmedi. Ameliyat sonrası kavrama gücü ortalaması 37.3±3.0 kg idi. Herbert-Fisher sınıflamasına göre mükemmel ve iyi sonuç oranı %61.5, orta ve kötü sonuç oranı %38.5 idi ve ortalama Mayo skoru ise 80±13 idi. Sonuç: Çalışmamızda proksimal skafoid kaynamamaları için nonvaskülarize otogreftleme ve vida tespiti ile tedavi edilen hastalarda tatminkar sonuçlar elde edilemedi. Açık cerrahi ve greftleme işleminin, skafoid kemiğin vasküler beslenmesi üzerine olan olumsuz etkileri nedeniyle greftlemenin seçilmiş olgularda uygulanması gerektiğini düşünüyoruz.Anahtar sözcükler: Kemik grefti; kırık; kaynamama; skafoid; vaskü-larize kemik grefti. Objectives:In this study, we aimed to evaluate the results of proximal scaphoid nonunion treated with nonvascularized bone grafting and screw fixation. Patients and methods: Thirteen patients who were treated surgically for proximal scaphoid nonunion with a minimum of one-year follow-up in our clinic were evaluated. Wrist movements were measured by standard goniometry and muscle strength by hand dynamometry. Nonunion was classified radiologically according to the Schernberg classification, while functional assessment was performed based on the Herbert-Fisher Grading System and the Mayo Clinic Modified Wrist Scoring System. Results: The mean follow-up period was 14 months (range, 12 to 40 months). Full union was observed in eight of 13 patients (61.5%). The mean time to union was 16 (range, 12 to 40) weeks. There was no loss of function of more than 10% compared to the healthy hand in the cases with full union. Postoperative mean grip strength was 37.3±3.0 kg. The rates of excellent and good results were 61.5%, moderate and poor results were 38.5% according to the Herbert-Fisher classification and the mean Mayo score was 80±13. Conclusion: We obtained no satisfactory results in patients treated with nonvascularized bone grafting and screw fixation for proximal scaphoid nonunions. We suggest that grafting should be carried out in selected cases due to the adverse effects of open techniques and bone grafting on vascularity of scaphoid bone.

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Herbert Screw Fixation for Scaphoid Nonunions; An Analysis of Factors Influencing Outcome

Cited by 62 publications

References 16 publications

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Retrospective Review of 234 Scaphoid Fractures and Nonunions Treated with Arthroscopy for Union and Complications

Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Is nonvascularized autografting in the proximal scaphoid nonunions ineffective?

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