Scaphoid Reconstruction

Borges, Cristian Stein; Ruschel, Paulo Henrique; Pignataro, Milton Bernardes

doi:10.1016/j.ocl.2019.08.010

Cited by 11 publications

(7 citation statements)

References 55 publications

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“…The proximal scaphoid is at risk of avascular necrosis after fracture, further limiting the potential recovery (Papatheodorou et al, 2021). Several surgical procedures have been developed to try to improve bone union, including various bone grafts (Borges et al, 2020; Jerome et al, 2020; Kim et al, 2018; Pulos et al, 2018). Union rates with traditional bone grafts used for proximal scaphoid nonunion have been reported to be between 64% and 74% (Krimmer, 2002; Morris et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle

Polat¹,

Toy²,

Kibar

2022

J Hand Surg Eur Vol

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Fractures of the proximal scaphoid waist are more prone to nonunion than distal scaphoid fractures. Thirty-nine patients (five females, 34 males; mean age 31 years) who had operation for proximal scaphoid waist nonunion between 2017 and 2020 were retrospectively analysed. Patients received a free vascularized medial femoral condyle graft (Group 1: 18 patients) or distal radial bone graft based on a 1,2 intercompartmental supraretinacular artery pedicle (Group 2: 21 patients). In Group 1, union was achieved in 17 of 18 cases, with mean time to union of 13 weeks and mean operation time was 221 minutes. In Group 2, union was achieved in 19 of 21 cases, with mean time to union of 15 weeks and mean operation time was 100 minutes. The radiological and functional results of both groups were similar. We recommend a distal radial bone graft based on the 1,2 intercompartmental supraretinacular artery pedicle for proximal scaphoid waist nonunions since the operation is shorter, technically more manageable and requires less microsurgical experience. Level of evidence: III

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Section: Introductionmentioning

confidence: 99%

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle

Polat¹,

Toy²,

Kibar

2022

J Hand Surg Eur Vol

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“…Scaphoid fracture is the most common carpal fracture, accounting for 60% of fractures in the carpus. [1] However, scaphoid fracture is frequently missed on initial plain radiographs. [ 2 3 ] When scaphoid fracture is not detected early, heavy biomechanical loading and precarious blood supply usually cause nonunion.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 5 6 7 ] Scaphoid nonunion has a predictable outcome. [ 1 8 ] The distal scaphoid fragment moves with the distal carpal row and the proximal scaphoid fragment moves together with the lunate. Bone resorption at the fracture site caused by abnormal movement leads to collapse of the scaphoid into flexion, and the lunate becomes extended through the extension force transmitted to the lunate through the lunotriquetral ligament.…”

Section: Introductionmentioning

confidence: 99%

Double trapezia sign

Lee¹,

Hwang²,

Park

et al. 2020

Medicine

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In scaphoid nonunion, pseudarthrosis and sclerotic change occur at the nonunion site. These changes make a distal fragment look like a trapezium on plain radiographs and we called this phenomenon the double trapezia sign. The purpose of this study was to estimate the diagnostic reliability of the double trapezia sign and its clinical and prognostic implications for the scaphoid nonunion. A retrospective review of 124 patients who underwent surgical treatment because of scaphoid nonunion between January 2007 and December 2017 was performed. Two hand surgeons and 1 musculoskeletal radiologist reviewed preoperative plain radiographs independently. Each observer evaluated the plain radiographs in 2 separate sessions at least 3 weeks apart to assess intraobserver and interobserver reliabilities of the double trapezia sign. To assess clinical and prognostic implications of the double trapezia sign, the patients were divided into the positive and nonpositive groups, and several variables such as age, sex, duration of nonunion, size of the distal fragment, avascular necrosis (AVN) of the proximal fragment, type of bone graft, healing time, and failure rate were compared between the 2 groups. The kappa values of intraobserver and interobserver reliabilities were >0.8, corresponding to almost perfect agreement. There were 58 patients in the positive group and 66 patients in the nonpositive group. The mean duration of nonunion was 38.5 months in the positive group and 12.2 months in the nonpositive group ( P < .001). The size of distal fragment was 49.6% and 60.9%, respectively ( P < .001). The AVN of proximal fragment was 24.1% and 54.5%, respectively ( P = .001). The mean healing time was 4.1 and 6.4 months, respectively ( P < .001). The failure rate was 13.8% and 27.3%, respectively ( P = .066). In conclusion, the double trapezia sign is a valuable radiographic sign of scaphoid nonunion. The double trapezia sign is easily identifiable on plain radiographs and has excellent intra- and interobserver reliabilities. The positive double trapezia sign implies mid-waist nonunion, long duration of nonunion, less possibility of AVN, and favorable postoperative prognosis.

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“…One case with scaphoid nonunion (undergoing scaphoid nonunion surgery through non-vascularized bone grafting 13 months before; Slade and Geissler Type 5), three cases with Kienböck's disease (one with Lichtman Type 2, two with Lichtman Type 3a), and two cases with traumatic metacarpal defects were selected for the study (Table I). [17,18] A written informed consent was All the patients were male. The median age of the patients was 22.5 (range, 20 to 24) years.…”

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confidence: 99%

A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series

Orman

Eren

Kara³

et al. 2021

Jt Dis Relat Surg

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Objectives: This study aims to describe our surgery technique and discuss patients treated through the dorsoulnar artery (DUA)-based technique of osseous and osteo-fascio-cutaneous vascularized ulnar bone grafting. Patients and methods: Between January 2011 and January 2015, six male patients (median age: 22.5 years; range, 20 to 24 years) who underwent surgery during which the technique of DUA ulnar bone graft was utilized. One patient with scaphoid nonunion, three patients with Kienböck’s disease, and two patients with a traumatic metacarpal defect were retrospectively evaluated. The joint range of motion (ROM), grip strength, Disabilities of the arm, shoulder and Hand (DASH) questionnaire score and Visual Analog Scale (VAS) score, and radiographies before and after surgery were examined. Scintigraphy was performed at 12 weeks postoperatively to monitor the viability of the bone graft. Results: All patients showed improvements in the ROM, grip strength, VAS, and DASH scores. According to the radiographic examination, bone union was achieved in all patients and the scintigraphy revealed that vascularization was detected in the bone tissue. Conclusion: The advantages of DUA-based vascularized bone graft are good bone quality and quantity and versatility due to its long pedicle. The osteo-fasio-cutaneous DUA flap seems to be effective in the treatment of traumatic metacarpal bone defects accompanied by skin loss. The DUA-based vascularized ulnar bone may be a source for scaphoid and lunate biological bone reconstruction.

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Scaphoid Reconstruction

Cited by 11 publications

References 55 publications

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle

Double trapezia sign

A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series

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