Practicability of a locking plate for difficult pathologies of the scaphoid

Mehling, Isabella; Arsalan-Werner, Annika; Wingenbach, V; Seegmüller, Jessica; Schlageter, M; Sauerbier, Michael

doi:10.1007/s00402-019-03196-6

Cited by 18 publications

(20 citation statements)

References 31 publications

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“…Ultimately, 23 studies were included for final data extraction and analysis. 11,12,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] ►Fig. 1 outlines the results of the literature search and article selection.…”

Section: Resultsmentioning

confidence: 99%

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

et al. 2021

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Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions. Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution. Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores. Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.

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Section: Resultsmentioning

confidence: 99%

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

et al. 2021

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“…The authors used the palmar locking plate for difficult bony fixations or reduction of advanced instabilities. Mehling et al demonstrated good clinical and radiological results with palmar locking plates in difficult pathologies of the scaphoid, but also observed that most patients will require hardware removal and therefore recommended it as a rescue option [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

Keller

Kastenberger

Anoar

et al. 2020

Arch Orthop Trauma Surg

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Introduction This study evaluated the use of a free vascularized bone graft with and without cartilage from the medial femoral condyle (MFC) in patients with recalcitrant scaphoid non-union, with a special focus on union rates and the osteochondral graft for proximal pole destruction. Materials and methods Thirty-eight avascular scaphoid non-unions in 37 patients who were treated with a free osteoperiosteal or osteochondral MFC graft were retrospectively evaluated (mean follow-up 16 months). Bone union, the scapholunate and the radiolunate angles were evaluated on X-ray images. The range of motion, grip strength, VAS, DASH and PRWE scores were evaluated clinically. Results The overall union rate was 95%. Bone union was achieved in 27 out of 29 (93%) scaphoids treated with a free osteoperiosteal MFC grafts and in 9 out of 9 (100%) scaphoids treated with a free osteochondral MFC graft. The range of motion remained almost unchanged, while grip strength increased significantly (34 kg vs. 44 kg) and the VAS (22-5), DASH (59-19) and PRWE (62-30) score decreased significantly. The scapholunate (71°-65°) and radiolunate (28°-18°) angle decreased. No major donor site morbidity was observed. Postoperative complications were observed in eight cases (21%). Conclusions The vascularized medial femoral bone graft leads to a good functional outcome in the treatment of scaphoid non-unions. The graft provides adequate blood supply and structural stability to the scaphoid. A proximal pole destruction can be replaced using an osteochondral graft with promising short-term results preventing carpal osteoarthritis and collapse.

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“…It also stops graft extrusion, and can be utilized for fracture configurations that would not be stabilized by a screw. 10,23 It has significantly more rotational stability than a single screw, although not two parallel cannulated compression screws. 6,24,25 However, it is subject to concentrated strain due to the small working distance if locking screws are used.…”

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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Practicability of a locking plate for difficult pathologies of the scaphoid

Cited by 18 publications

References 31 publications

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes

Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

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