Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting

Gvozdenovic, Robert; Kongensgaard, Trine Broenden

doi:10.1177/17531934231166343

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…Indeed, Gvozdenovic and Kongensgaard recently reported that arthroscopic bone grafting leads to more rapid union than open bone grafting in the setting of scaphoid nonunions, by an average of 5.4 weeks (p ¼ 0.033). 17 Standard fixation constructs have inherent drawbacks. Although cheap and widely available, K-wires can be malleable, confer the risk of pin-site infection, and require a prolonged period of immobilization and a secondary operation for hardware removal.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Sivakumar,

Ang,

Smith

2024

J Wrist Surg

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Background The optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union. Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims. Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures. Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score. Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Sivakumar,

Ang,

Smith

2024

J Wrist Surg

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Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases

Delamarre,

Leroy,

Barbarin

et al. 2023

Eur J Orthop Surg Traumatol

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Arthroscopic assisted versus open non-vascularized bone grafting in delayed union and nonunion of the scaphoid: a systematic review and meta-analysis

Noori,

Persitz,

Khan

et al. 2024

BMC Musculoskelet Disord

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Background Delayed union and nonunion of the scaphoid is a common complication often requiring surgical reconstruction and bone grafting. Our goal was to systematically assess the healing time and clinical outcomes following arthroscopic-assisted versus open non-vascularized bone grafting of the scaphoid. Methods A comprehensive search of the MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central databases was completed from inception to September 2023. We included randomized trials and observational studies that reported outcomes following scaphoid delayed union/nonunion comparing arthroscopic-assisted vs. open non-vascularized bone grafting. Two reviewers independently extracted data and assessed the risk of bias. One investigator assessed certainty of evidence and a senior investigator confirmed the assessment. We pooled effects using random-effects models, when possible, for all outcomes reported by more than 1 study. Results Overall, 26 studies and 822 patients were included in the study. Very low certainty evidence demonstrated that arthroscopic-assisted surgery may decrease healing time compared to open surgery (weighted mean difference [WMD] -7.8 weeks; 95%CI -12.8 to -2.8). Arthroscopic bone grafting did not result in an improvement in union rate (relative risk 1.01; 95%CI 0.9 to 1.09). The pooled data in arthroscopic graft group showed mean time to union of 11.4 weeks (95%CI: 10.4 to 12.5) with union rate of 95% (95%CI 91–98%). A single comparative study reported very low certainty evidence that arthroscopy-assisted vs. open surgery may not have an effect on pain relief (MD 0 cm, 95%CI -0.4 to 0.5 on VAS 10 cm for pain) or improving function (MD -1.2, 95% CI -4.8 to 2.3 on 100 points DASH). Conclusion and future directions Our results suggest that arthroscopic-assisted non-vascularized bone grafting may be associated with improved average weeks to heal in comparison with open surgery for scaphoid delayed union/nonunion reconstruction with overall comparable union rates. There is insufficient evidence to assess the effects of arthroscopic-assisted reconstruction on union rate, time to union, and patient-reported outcomes in patients with other important nonunion characteristics such as established humpback deformity.

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Results of arthroscopic cancellous bone grafting for treatment of scaphoid nonunion in comparison with open cancellous bone grafting

Cited by 3 publications

References 32 publications

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion

Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases

Arthroscopic assisted versus open non-vascularized bone grafting in delayed union and nonunion of the scaphoid: a systematic review and meta-analysis

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