Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial

Hegazy, Galal; Alshal, Ehab; Abdelaal, Mohamed; Abdelaziz, M.; Moawad, Mohamed A.; Saqr, Yasser; El-Sebaey, Ibrahem; Abdelazeem, Mokhtar Elsayed; El-Barody, Mohamed M.

doi:10.1007/s00264-020-04730-7

Cited by 9 publications

(14 citation statements)

References 32 publications

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“…The size and shape of the scaphoid bone, the position of fracture line and the characteristics of blood supply must be considered in the selection of xation methods for scaphoid fractures [9]. The malunion or nonunion with malalignment will result in a dorsal intercalated segmental instability (DISI) deformity, following by carpal collapse and eventual osteoarthrosis, the so-called scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) wrist [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation on the nonunion of scaphoid

Lyu

Wang

et al. 2023

Preprint

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Background The high incidence of scaphoid nonunion occurs after the scaphoid fracture due to the vulnerable blood supply. The complications of scaphoid nonunion, such as predicatable pattern of carpal collapse and degenerative arthritic will take place without treatment. Patients will suffer from pain of bone and poor functional in the early and late stage of the progression, which can significantly affect quality of life. Therefore, it is of great important to chose an operative technique which can get a high success rate for union. This paper introduced a technique for the treatment of scaphoid nonunion with pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation. Methods A retrospective review a senior surgeon's internship at a private university from 2010 to 2021 was performed. Demographic information and the characteristics of patients were obtained for preoperative and postoperative assessment. Student’s t tests was used to evaluate pre-operative, post-operative, and the last follow-up differences. p≤0.05 was indicated that the difference was statistically significant. Results： Totally 18 patients were identified for inclusion in this study. 100% of the patients achieved union at the last follow-up. The average age was 27.22 (17-49). The time from injury to surgery was 12.94 (1-48) months, with the median of 41.86 weeks. The average healing time from surgery was 15.27 (10-27)weeks. The time of follow-up was 49.5 (4-119)months. We evaluated the ideal range of scaphotomy by comparing scaphoid length and postoperative scaphoid shortening rate. The rate of scaphoid shortening was 4.288% (0.40%-9.05%). There were statistically significant differences among the scapholunate angle, the radiolunate angle, the mean scapholunate interval, the post-op Quick DASH, the VAS pain score, the Grip strength and the range of motion before, after surgery and at the last follow-up all had significant improvement(p＜0.05). There were no difference in time of union bewteen different patient ages, different fracture locations, smoking or not, alcohol consumption or not , or time of treatment. Conclusions： Our method have equal or superior union rate comparing to other techniques in the literature. This paper highlighted the keys to use this method successfully.

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Section: Discussionmentioning

confidence: 99%

Clinical effect of pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation on the nonunion of scaphoid

Lyu

Wang

et al. 2023

Preprint

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“…The use of conventional radiographs in the assessment of fusion in SNU treatment is found in other reports. [4,9,13,14,30,35,42]. Viability could be estimated on MRI [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of SNU most often involves the use of bone grafts [11] with internal fixation; K wires and screws with a variety of compression forces are available for scaphoid fixation [5,[12][13][14]. An ideal bone graft facilitates bone healing, increases bone density (ensuring greater stability), and is compatible with the essential bone mass, involving no morbidity for the donor site.…”

Section: Introductionmentioning

confidence: 99%

Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion

Matić

Vuckovic²,

Lešić

et al. 2020

International Orthopaedics (SICOT)

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Introduction Fractures of the scaphoid account for 60-70% of all wrist bone fractures. The results of treatment in terms of bone healing vary depending on the type and location of the fracture, the time elapsed since the injury, the type of surgical treatment. Nonunion occurs in 5-15% of the cases on average. The purpose of this paper is to compare the surgical techniques and results of treating scaphoid nonunion (SNU) with osteoplastic xenografts of bovine origin or a vascularized autograft of the distal part of the dorsal radius. Methods We compare two groups of patients with symptomatic SNU, treated surgically with either a vascularized graft (n = 15) or a xenograft of bovine origin (n = 15). In the presurgical stage, the demographic characteristics of the patients, the time elapsed between injury and surgery, and classification of the injury (Schonberg, Herbert-Fisher, and Geissler-Slade) were recorded. One year following surgery, bone healing, total duration of the treatment, complications, the Mayo wrist score, and answers to the DASH questionnaire were analyzed.Results No statistically significant differences between the two groups of patients were observed for bone healing (86.7% vs 80%) or functional results. A highly significant difference was observed with respect to duration of the surgical intervention in favor of xenografts. Conclusion The xenograft method is simple and relatively acceptable, providing good results in terms of healing and functionality.

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“…A 10 cm VAS scale (0 = no pain, 10 = total pain) was used by a pain specialist (YL) at each follow-up to assess the patient's pain level. Few scaphoid waist fracture patients reported greater pain (VAS > 4 cm) within 1 year after treatment in previous studies [16,17]. Therefore, 4 cm was defined as the cutoff score of this study.…”

Section: Primary Outcome Measuresmentioning

confidence: 94%

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Gong

Zhao

Liu

et al. 2022

BMC Musculoskelet Disord

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Background The aim of this prospective study was to assess the incidence of complex regional pain syndrome type I (CRPS I) in patients with scaphoid waist fracture and to explore associated factors. Methods This was a multicenter, prospective observational study. Demographic, imaging indicators and clinical data were collected before the conservative treatment of scaphoid waist fracture patients. The occurrence of CRPS I and pain condition were the main outcomes. To explore the factors associated with CRPS I, multivariate logistic regression model was used. Results A total of 493 scaphoid waist fracture participants undergoing conservative treatment were recruited for this study. The incidence of CRPS I was 20% (n = 87). The average time between injury and the onset of CRPS I was 6.7 ± 2.1 weeks. Multivariable logistic regression analysis revealed that female sex (odds ratio (OR): 1.669; 95% confidence interval (CI): 1.189–2.338), diabetes mellitus (OR: 3.206; 95% CI: 2.284–4.492), and severe pain condition before treatment (visual analog scale (VAS) score more than 4 cm) (OR: 27.966; 95% CI: 19.924–39.187) were independently associated with CRPS I. Conclusions Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. Early screening and regular follow up evaluation are recommended in these patients.

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Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial

Cited by 9 publications

References 32 publications

Clinical effect of pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation on the nonunion of scaphoid

Clinical effect of pseudarthrosis excision, processus styloideus radii osteotomy combined with headless compression screw fixation on the nonunion of scaphoid

Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

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