Treatment of unstable scaphoid waist nonunion with cancellous bone grafts and cannulated screw or Kirschner wire fixation

Hegazy, Galal; Seddik, Mahmoud; Abd-Elghany, Tharwat; Abdel-AAl, Mohamed; Abdelaziz, M.; Elzahed, Ehab; Saqr, Yasser; Seif, Elsayed

doi:10.1080/2000656x.2020.1856674

Cited by 8 publications

(29 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

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

Section: Resultsmentioning

confidence: 99%

“…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…”

Section: Methodsmentioning

confidence: 99%

Bone grafting for scaphoid nonunion surgery

Duncumb

Robinson

Williamson

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

show abstract

“…The use of multiple K-wires for treatment of the scaphoid nonunion is common, due to its superiority in bony union. In a most recent study by Hegazy et al [ 15 ], three convergent 1.1-mm K-wires were placed in retrograde manner for stabilizing scaphoid fracture nonunion, and the union rate was 98% in the K-wire group vs 89% in the Herbert screw group, as well as the shorter union time (12 vs 15 weeks). Chen et al [ 16 ] used divergent K-wires to stabilize the reduced scaphoid fragments in 26 patients with scaphoid nonunion, and the 3 to 6-year follow-up assessments showed the 100% union rate within postoperative 4 months and the good or excellent functional outcomes in all patients.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that, use of multiple K-wires alone may not adequately resist the bending forces when fingers are moving to generate the axial compression force at the fracture site. This can partially explain why the long immobilization period was needed in some studies [ 15 , 16 ]. On the other hand, relative to K-wires, a single cannulated screw has superiority in resisting bending force, but may not adequately withstand cyclical rotation or multi-axis loading [ 18 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cannulated compression screw with versus without two K-wire fixation for treatment of scaphoid waist fracture nonunion

Zhang

Wang

et al. 2022

J Orthop Surg Res

View full text Add to dashboard Cite

Purpose This study aims to introduce the “tripod” technique using cannulated compression screw and two anti-rotational K-wires for treatment of unstable scaphoid waist fracture nonunion, and to compare it with the single cannulated screw fixation technique in term of scaphoid union and surgical outcomes. Methods It was a retrospective study. From January 2014 to March 2020, 103 consecutive patients with scaphoid waist fracture nonunion treated with the tripod fixation and bone grafting (n = 45) or with single cannulated compression screw and bone grafting (n = 58) were included. All the procedures were performed by the same hand surgery team, and autologous cortico-cancellous radius bone graft was used for bony reconstruction. The minimal follow-up period was 12 months. The union rate and the time to union, range of motion (ROM), grip strength, Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) score and modified Mayo Scores at the last visit were compared. Results In tripod fixation group, bony union was achieved in all patients at the mean of 14.8 ± 3.8 weeks, while in the single cannulated screw fixation group the bony union rate was 94.8% (55/58) and the time to union was 17.6 ± 3.6 weeks. The difference of time to union was statistically significant (p = 0.027), but not for bony union rate (p = 0.122). At the last visit, no significant difference was found with respect to any clinical and radiographic outcome measures (all p > 0.05). The overall rate of complications was not significantly different between two groups (15.6% vs 10.3%, p = 0.430). Conclusions Tripod fixation technique with headless compression screw and two K-wires is a safe and effective technique for treatment of scaphoid nonunion fixation and can be considered to use in practice, especially for those potentially rotationally unstable cases.

show abstract