Structural Versus Nonstructural Bone Grafting for the Treatment of Unstable Scaphoid Waist Nonunion Without Avascular Necrosis: A Randomized Clinical Trial

Hegazy, Galal; Massoud, Abdel-Hakim; Seddik, Mahmoud; Abd-Elghany, Tharwat; Abdelaal, Mohamed; Saqr, Yasser; Abdelaziz, M.; Zayed, Emad; Hassan, Mohamed M.

doi:10.1016/j.jhsa.2021.01.027

Cited by 18 publications

(18 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A randomized clinical trial of scaphoid nonunion surgical procedures comparing corticocancellous and cancellous-only bone graft showed that union rates were not significantly different, but that malunions were higher in patients with cancellous-only graft, and QuickDASH scores were significantly better in the corticocancellous group than in the cancellous-only group. These results suggest that the correction of deformity is important and may be better with corticocancellous grafts 39 .…”

Section: Wrist Traumamentioning

confidence: 79%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

show abstract

Section: Wrist Traumamentioning

confidence: 79%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…A total of 78 studies met the inclusion criteria and are listed in detail in Supplementary Table i. 8-10,12,13,15-86 The year of publication ranged from 1988 to 2021. There was a total of 7,671 patients included across all studies.…”

Section: Resultsmentioning

confidence: 99%

“…Studies that excluded patients with both proximal pole fractures and AVN (n = 14), had a mean union rate of 96.5% (95% CI 94.2 to 98.9), significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies in this review (p < 0.001). Of the studies that excluded AVN and proximal pole fractures, 13 used non-vascularized grafts, 12,13,30,57,58,60,66,69,76-78,80,87 and one used a pedicled vascularized graft from the distal radius. 40…”

Section: Resultsmentioning

confidence: 99%

“…AO screws were defined as fully threaded cortical screws, while compression screws were defined as 'Herbert' screws or variable pitched screws. Due to the likely overlap of patients undergoing fixation using a Herbert screw reported by two studies found in the search, 12,13 only nonunions fixed with Kirschner (K)-wires were included from one retrospective observational study. 12 Outcome measures.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Bone grafting for scaphoid nonunion surgery

Duncumb

Robinson

Williamson

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN). Methods A search of PubMed, MEDLINE, and Embase was performed in June 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and registered using the PROSPERO International prospective register of systematic reviews. The primary outcome was union rate. Results There were 78 studies that met the inclusion criteria with a total of 7,671 patients (87.8% male, 12.2% female). The mean age was 27.9 years (SD 3.8) and the mean follow-up was 30.9 months (SD 25.9). The mean union rate was 88.7% (95% confidence interval (CI) 85.0 to 92.5) for non-vascularized grafts versus 87.5% (95% CI 82.8 to 92.2) for vascularized grafts (p = 0.685). Pooled analysis of trial data alone found a mean union rate of 82.4% (95% CI 66.9% to 97.9%) for non-vascularized grafts and 89.4% (95% CI 84.1% to 94.7%) for vascularized grafts (p = 0.780). No significant difference was observed in union rates between any of the fixation techniques used in the studies (p = 0.502). Distal radius and iliac crest graft source had comparable mean union rates (86.9% (95% CI 83.1 to 90.7) vs 87.6% (95% CI 82.2 to 92.9); p = 0.841). Studies that excluded patients with both proximal pole fractures and AVN (n = 14) had a mean union rate of 96.5% (95% CI 94.2 to 98.9) that was significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies (p < 0.001). Conclusion Current evidence suggests vascularized bone grafting does not yield significantly superior results to non-vascularized grafting in scaphoid nonunion management. However, potential selection bias lessens the certainty of these findings. The fixation type or source of the graft used was not found to influence union rates either. Sufficiently designed and powered prospective randomized controlled trials in this area are needed. Cite this article: Bone Joint J 2022;104-B(5):549–558.

show abstract

“…HGS is associated with disability, frailty, and sarcopenia in adults, 1–4 and pediatric patients 5,6 . The evaluation of the upper extremity strength can be used to predict exacerbations in patients with chronic obstructive pulmonary disease, 2 the functional decline in the elderly, 7 muscle fatigability, 8 and functional outcomes in defined orthopedics patients 9–11 . HGS seems to furnish, together with other measurements, the frailty status also in patients with advanced heart failure 12,13 …”

Section: Introductionmentioning

confidence: 99%

Hand grip strength in patients with LVADs: A scoping review

Polastri¹,

Boschi²,

Tchantchaleishvili

et al. 2022

Artificial Organs

View full text Add to dashboard Cite

Hand grip strength (HGS) is a simple test to evaluate the upper limb strength in patients with different diseases. HGS is associated with disability, frailty, and sarcopenia in adults, 1-4 and pediatric patients. 5,6 The evaluation of the upper extremity strength can be used to predict exacerbations in patients with chronic obstructive pulmonary disease, 2 the functional decline in the elderly, 7 muscle fatigability, 8 and functional outcomes in defined orthopedics patients. 9-11 HGS seems to furnish, together with other measurements, the frailty status also in patients with advanced heart failure. 12,13 HGS has also been described as a practical test to define the degree of postoperative recovery after cardiac

show abstract

Structural Versus Nonstructural Bone Grafting for the Treatment of Unstable Scaphoid Waist Nonunion Without Avascular Necrosis: A Randomized Clinical Trial

Cited by 18 publications

References 36 publications

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Bone grafting for scaphoid nonunion surgery

Hand grip strength in patients with LVADs: A scoping review

Contact Info

Product

Resources

About