Scaphoid morphology and clinical outcomes in scaphoid reconstructions

Megerle, Kai; Harenberg, P.S.; Germann, G.; Hellmich, Susanne

doi:10.1016/j.injury.2011.08.015

Cited by 41 publications

(34 citation statements)

References 27 publications

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“…Many authors believe that occurrence of union alone is not enough to prevent secondary osteoarthritis and correction of the intrascaphoid angular malalignment is necessary to restore carpal kinematics and prevent degenerative changes in the future. 11,[14][15][16]22,23,32,33 However, while some surgeons have advocated treating symptomatic malunions of the scaphoid with a corrective osteotomy, 17,23,[34][35][36] others have questioned the correlation between the scaphoid malunion and clinical outcomes and do not recommend an osteotomy of a bone that is known to have difficulty obtaining union. 19,20,26,33,37 Lindstrom and Nystrom retrospectively studied 229 healed scaphoid waist fractures with a minimum follow-up of 7 years and found 5.6% of patients displayed patterns of radiographic radiocarpal arthrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Most frequently, it is simply mentioned as a potential complication of nonunion surgery or in association to ligamentous injuries around the scaphoid. 15,18,19,21,22 As a result, there is no clear consensus as to what degree of scaphoid deformity can be tolerated without compromising wrist function or how best to manage a patient who has healed with an asymptomatic malunion.…”

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confidence: 99%

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The Natural History of Scaphoid Fracture Malunion: A Scoping Review

et al. 2019

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Background A scaphoid malunion occurs when a scaphoid fracture heals in a nonanatomic position or when the fracture is fixed without correction of the sagittal angular deformity. Although altered carpal mechanics and early osteoarthritis have been suggested as natural sequelae, the natural history and clinical outcomes are debatable. Purposes The purpose of this study is to review and summarize the available literature regarding clinical, functional, and radiographic outcomes of patients with scaphoid malunion. Methods A systematic search of the MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science was performed to identify published studies concerning the clinical and radiological results of scaphoid malunion following either acute scaphoid fracture or surgically treated nonunions. Results Five publications with a total of 83 malunions were included in the final synthesis. The diagnosis of malunion was based on computed tomography by calculating the lateral intrascaphoid angle (threshold of 35 or 45 degrees) or height/length ratio (threshold of 0.6). Self-reported and clinical evaluation techniques varied between the studies and direct comparison was not possible between the different outcome measures. Most patients demonstrated arthritic changes; however, correlation with pain and functional results was not always present. Conclusions This scoping review confirmed that patients with malunited scaphoids seem to have higher likelihood of post traumatic arthritis. However, clinical implications remain uncertain and better methods for assessing and defining scaphoid deformity are required.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Natural History of Scaphoid Fracture Malunion: A Scoping Review

et al. 2019

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“…Proper restoration of anatomical carpal alignment and scaphoid morphology has been demonstrated to correlate with improved clinical outcomes in terms of grip strength, range of motion, and functional outcome scores. 18,19 Displacement and alignment can best be evaluated preoperatively with sagittal CT series in the long-axis plane of the scaphoid. A more accurate estimation of the flexion deformity may have significant implications such as potentially changing the surgeon's operative plan from a dorsal approach to a volar approach in an effort to correct the humpback deformity.…”

Section: Discussionmentioning

confidence: 99%

Importance of Computed Tomography in Determining Displacement in Scaphoid Fractures

et al. 2017

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Displaced scaphoid fractures have a relatively high rate of nonunion. Detection of displacement is vital in limiting the risk of nonunion when treating scaphoid fractures. We evaluated the ability to diagnose displacement on radiographs and computed tomography (CT), hypothesizing that displacement is underestimated in assessing scaphoid fracture by radiograph compared with CT. Thirty-five preoperative radiographs and CT scans of acute scaphoid fractures were evaluated by two blinded observers. Displacement and angular deformity were measured, and the fracture was judged as displaced or nondisplaced. Scapholunate, radiolunate, and intrascaphoid angles were measured. Radiograph and CT measurements between nondisplaced and displaced fractures were compared. Intraobserver reliability was measured. Reader 1 identified 12 fractures as nondisplaced on radiograph, but displaced on CT (34%). Reader 2 identified 9 fractures as nondisplaced on radiograph, but displaced on CT (26%). For displaced fractures, the mean intrascaphoid angle was over three times greater when measured on CT than on radiograph (56 vs. 16 degrees). Scapholunate angle >65 degrees and radiolunate angle >16 degrees were significantly associated with displacement on CT. Interobserver reliability for diagnosing displacement was perfect on CT but less reliable on radiograph. Scaphoid fracture displacement on CT was identified in 26 to 34% of fractures that were nondisplaced on radiograph, confirming that radiographic evaluation alone underestimates displacement. These results underscore the importance of CT scan in determining displacement and angular deformity when evaluating scaphoid fractures, as it may alter the decision on treatment and surgical approach to the fracture. We recommend considering CT scan to evaluate all scaphoid fractures. Level III.

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“…samten Handgelenkes nach sich zieht [1]. Entsprechend zielt die Behandlung darauf ab, nicht nur die ossäre Kontinuität und Tragfähigkeit wiederherzustellen, sondern auch bestmöglich die ursprüngliche Form [2][3][4]. Denn bereits bei leichtgradigen Formveränderungen kommt es zu einer Beeinträchtigung der Beweglichkeit [5], Kraftverlust, Schmerzen und vermehrtem Aufkommen von Arthrosen [6,7].…”

Section: Einführungunclassified

Kahnbeinpseudarthrose: computerassistierte virtuelle Planung der Rekonstruktion

Nagy

2020

Handchir Mikrochir Plast Chir

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ZusammenfassungDie eigentümliche Form des Kahnbeins ist eine Herausforderung für unser räumliches Vorstellungsvermögen. Deshalb bietet gerade bei der Rekonstruktion von Kahnbeinpseudarthrosen die Computer-Unterstützung unvergleichliche Vorteile: Sie ermöglicht die Erstellung eines echten 3-dimensionalen interaktiven Modells aus CTs, das manipuliert, bearbeitet und bei Bedarf sogar physisch gedruckt werden kann. Der Vergleich mit dem gesunden Kahnbein der Gegenseite analysiert die exakte Fehlstellung und erlaubt damit die Planung einer präzis-anatomischen Wiederherstellung der Kahnbeinform. Schließlich erleichtern computergenerierte patientenspezifischen Instrumente intraoperativ die genaue Umsetzung der Planung. Dieses Vorgehen ermöglicht es, das Kahnbein wesentlich exakter als zuvor wiederherzustellen und damit auch zuverlässiger die gestörte Handgelenkskinematik zu normalisieren. Unterdessen haben wir diese Technik bei der Rekonstruktion von über 50 fehlgestellten Kahnbeinpseudarthrosen erfolgreich angewandt.

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Scaphoid morphology and clinical outcomes in scaphoid reconstructions

Cited by 41 publications

References 27 publications

The Natural History of Scaphoid Fracture Malunion: A Scoping Review

The Natural History of Scaphoid Fracture Malunion: A Scoping Review

Importance of Computed Tomography in Determining Displacement in Scaphoid Fractures

Kahnbeinpseudarthrose: computerassistierte virtuelle Planung der Rekonstruktion

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