The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid

Ramamurthy, Chandarasekaran; Cutler, L.; Nuttall, D.; Simison, A. J. M.; Trail, I. A.; Jc, Stanley

doi:10.1302/0301-620x.89b5.18183

Cited by 71 publications

(57 citation statements)

References 30 publications

(43 reference statements)

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“…23) There were relatively large numbers of non-unions in these locations in our study. We found no significant difference in radiologic and functional outcomes between these two locations.…”

Section: Discussionmentioning

confidence: 73%

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Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques

Kiran

Persaud

Jariwala

et al. 2017

J Hand Surg Asian-Pac Vol

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Background: Scaphoid non-union is often caused due to missed fractures, inadequate or inappropriate management. Matti-Russe and interpositional grafting techniques are used in the treatment of non-union. There are very few studies in literature that compare the outcomes of these techniques. The aim of our study was to analyse the factors influencing outcome in the management of scaphoid non-union and to compare the results of the Matti Russe procedure with interpositional grafting techniques. Methods: Fifty scaphoid non-unions with a mean follow-up of 39.9 ± 5.5 months were included in this retrospective study. Demographic parameters, treatment, functional and radiological outcomes were recorded. The influence of demographic and treatment factors on union in this cohort was statistically analysed. Results: Union was achieved in 76% of cases. Good to excellent results were achieved in 84% of patients. There was no significant difference in union rates, deformity correction achieved and period of immobilisation between the MR and IG techniques. The occurrence of arthritic changes correlated with the time interval between injury and surgery (p = 0.002). Conclusions: The most important factor that influences the outcome is the time period between the occurrence of the fracture and surgery for non-union. The Matti-Russe procedure can achieve comparable results to interpositional grafting techniques with a shorter period of immobilisation than previously thought to be required. We believe that the presence of a deformity is not a contraindication for the procedure.

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Section: Discussionmentioning

confidence: 73%

“…22) Fracture location was assessed according to the fragment ratio method used by Ramamurthy et al on the postero-anterior radiograph. 23) Based on the fragment ratio, the location of the fracture was divided into the three thirds of the scaphoid. The middle third was further divided into proximal and distal halves.…”

Section: Methodsmentioning

confidence: 99%

Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques

Kiran

Persaud

Jariwala

et al. 2017

J Hand Surg Asian-Pac Vol

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“…The advantage of our material is in a relatively shortlasting nonunion (a mean of 10 months). It is suggested that if bone consolidation is not achieved within six months, operative treatment should be considered (3,4,31).…”

Section: Discussionmentioning

confidence: 99%

“…In Markowicz' study, in only 15 out of 48 patients (31%) was the fracture diagnosed, but in only in 2 (4%) was the diagnosis immediately after injury (1). Because of this, and because of the specific vascularity of scaphoid bone (the primary arterial supply enters the bone from distal pole), nonunion of the scaphoid is quite common, reaching a rate of up to 25-45% in proximal pole fracture (2,3). Operative treatment of scaphoid fracture decreases the rate of the late nonunion (4,5).…”

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confidence: 99%

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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Żyluk¹,

Walaszek²

2008

Polish Journal of Surgery

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Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist. The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius. Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score. Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.

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Scaphoid Non Union

Krimmer¹

2014

Disorders of the Hand

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The factors affecting outcome after non-vascular bone grafting and internal fixation for nonunion of the scaphoid

Cited by 71 publications

References 30 publications

Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques

Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques

Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

Scaphoid Non Union

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