Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions

Dodds, Seth D.; Halim, Andrea

doi:10.1016/j.jhsa.2016.04.021

Cited by 38 publications

(35 citation statements)

References 30 publications

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“…Ensuring the bone graft is providing structural correction of the humpback without the plate helps to achieve this. Similar to our case, fractured screws and plates have been described with a vascularized graft 26 and another with cancellous bone. 13,15 Biomechanically, the plate has a similar load to failure (maximum force a structure can resist) to a headless compression screw 27 but was a less stiff construct (or less resistant to deformation), partly due to the thin 0.8-mm profile, although it has more resistance to rotational deformity.…”

Section: Discussionsupporting

confidence: 86%

“…In our clinical experience with our one patient who fractured the screw (see above in complications section) and in the literature reports, 15,26 the construct tends to fail in the 1.5-mm screw shafts, just below the locked portion of the screw. Screws have also backed out of the plate, 15 and although there are reports of using cortical screws with success, we use locked screws.…”

Section: Discussionmentioning

confidence: 68%

“…However, our loss to follow-up is consistent with other studies of this trauma setting. 26 We used a mixture of cancellous and corticocancellous graft based on defect size with both radial and iliac autograft. We did not make any assessments of vascularity.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 68%

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Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

et al. 2020

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“…Four articles regarding the use of volar radial bone grafts for scaphoid nonunion and one study for Kienböck's disease met inclusion criteria and were included in the study. 14,[39][40][41][42] In total there were 132 patients with scaphoid nonunion. A clear mention regarding the presence or not of avascular necrosis was given only in two studies.…”

Section: Volar Bone Grafts From the Distal Radiusmentioning

confidence: 99%

The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Tsantes

Papadopoulos

Gelalis

et al. 2019

Journal of Hand and Microsurgery

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Background Vascularized bone grafts have become one of the first treatment options for scaphoid nonunions and Kienböck's disease. The aim of this study is to review the current body of the literature regarding the use of four vascularized bone grafts (1,2 ICSRA [1,2 intercompartmental supraretinacular artery] graft, 4+5 ECA [4+5 extracompartmental artery] graft, volar radial graft, and free medial femoral condyle graft) in these pathologies. Patients and Methods A search on MEDLINE and Google Scholar was performed. Exclusion criteria included language other than English, studies with no full text available, case reports, letters, editorials, and review articles. The primary outcomes included consolidation rate of the grafts and time to union regarding scaphoid nonunion, as well as the clinical outcomes (pain, grip strength, range of motion), revascularization of the lunate, and progression of the disease regarding Kienböck's disease. Results A total of 37 articles were included in the study enrolling 917 patients. Regarding scaphoid nonunion, the consolidation rate was 86.3% for the 1,2 ICSRA graft, 93.9% for the volar radial bone graft, and 88.8% for the free medial femoral condyle graft. In patients with Kienböck's disease, progression of the disease was observed in 13% of patients, and grip strength and pain were substantially improved whereas range of motion did not demonstrate statistically significant improvement (p < 0.05). Conclusion Vascularized bone grafts yield successful outcomes in patients with scaphoid nonunions demonstrating a high union rate. In patients with Kienböck's disease, vascularized grafts lead to revascularization of the lunate in most of the cases with concomitant improvement of the clinical parameters.

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“…14 Union was confirmed in eight out of nine (89%) patients. 33 In 2015 Bain et al found that dorsal scaphoid plating provides a more stable construct than the traditional Herbert screw and mitigates the need for vascular or cancellous bone grafting in most cases with a union rate of 90%. 15 We believe plate fixation has several advantages over single screw fixation and vascularized bone grafts.…”

Section: Discussionmentioning

confidence: 99%

Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion

et al. 2017

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Around 5 to 15% of all scaphoid fractures result in nonunion. Treatment of long-lasting scaphoid nonunion remains a challenge for the treating surgeon. Healing of scaphoid nonunion is essential for prevention of scaphoid nonunion advanced collapse and the subsequent predictable pattern of radiocarpal osteoarthritis. The purpose of this study was to investigate the feasibility of fixation of the scaphoid nonunion with a volar angular stable miniplate and cancellous bone grafting. We hypothesized that this technique could be successful, even in patients with previous surgery for nonunion and in patients with a long duration of nonunion. A total of 21 patients enrolled in a single-center prospective cohort study. Healing of nonunion was assessed on multiplanar computed tomography scan of the wrist at a 3-month interval. Functional outcome was assessed by measuring grip strength, range of motion, and by means of the patient-rated wrist and hand evaluation (PRWHE) questionnaire. During follow-up, 19 out of 21 patients (90%) showed radiological healing of the nonunion. The range of motion did not improve significantly. Postoperative PRWHE scores decreased by 34 points. Healing occurred regardless of the length of time of the nonunion (range: 6-183 months) and regardless of previous surgery (38% of patients). Volar angular stable miniplate fixation with autologous cancellous bone grafting is a successful technique for the treatment of chronic unstable scaphoid nonunion, even in patients with long-lasting nonunion and in patients who underwent previous surgery for a scaphoid fracture. Rotational interfragmentary stability might be an important determining factor for the successful treatment of unstable scaphoid nonunion. Level IV.

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Scaphoid Plate Fixation and Volar Carpal Artery Vascularized Bone Graft for Recalcitrant Scaphoid Nonunions

Cited by 38 publications

References 30 publications

Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

The Efficacy of Vascularized Bone Grafts in the Treatment of Scaphoid Nonunions and Kienbock Disease: A Systematic Review in 917 Patients

Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion

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