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Liau CJ, Liew SK, Arsad SR, Muhammad Nawawi RF, Silvanathan JP. Scaphoid Plate Osteosynthesis in Complex Fractures and Wrist Trauma: A Case Series. Cureus 2023; 15:e45067. [PMID: 37842372 PMCID: PMC10568241 DOI: 10.7759/cureus.45067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Treatment of scaphoid fracture is challenging due to its unique blood supply and geometry. Traditionally, a headless compression screw is the standard treatment for unstable scaphoid fracture. Some fractures are complex, for example, comminution with bone loss. A scaphoid plate is an option in these difficult fractures providing adequate rotational stability. Aim To share our experience in using scaphoid plates in complex wrist trauma and comminuted fractures. Method and material Complex wrist trauma involving scaphoid fractures that were comminuted and multi-fragmentary fractures treated with plate osteosynthesis were retrospectively reviewed between July 2019 and September 2021. Patient demographic data, preoperative radiographs, CT scans, pain, wrist range of motion, and fracture union rate to union were reviewed. Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH®) score was recorded at 1-year postoperative follow-up. Results Nine patients associated with complex wrist trauma were included in this case series. The mean follow-up was 2.5 years (13-30 months). The union rate was 100%. The mean arc of motion was 105° (95-110°). QuickDASH® score was 19.96 at 1-year postoperative follow-up. Four patients had good outcomes, four satisfactory, and one poor outcome. One hardware complication was observed which was the impingement of the plate proximally over the articular surface of the distal radius. Conclusion A scaphoid plate is a reliable option for treating complex and difficult fractures. It provides adequate stability, especially in comminution, bone loss, or multi-fragmentary fractures which are not amendable using other fixation methods. We recommend the expansion of plate osteosynthesis beyond scaphoid nonunion into complex wrist trauma.
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Affiliation(s)
- Chai Jiun Liau
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Selayang, Selangor, MYS
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Siew Khei Liew
- Hand & Microsurgery Unit, Orthopedics Department, University Putra Malaysia, Selangor, MYS
| | - Syahril Rizal Arsad
- Hand & Microsurgery Unit, Orthopedics Department, Hospital Selayang, Selangor, MYS
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Lemke KA, Mannambeth RV, Carman CJ, Csongvay S. Volar Plating of Scaphoid Fractures: A Retrospective Case Series. Hand (N Y) 2023; 18:46S-51S. [PMID: 35227110 PMCID: PMC10052624 DOI: 10.1177/15589447221075674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the rate of union of scaphoid fractures managed with volar plating and assess postoperative complications. METHODS Retrospective consecutive case series of 28 patients with scaphoid fractures, 9 acute and 19 chronic nonunions, undergoing surgical fixation with volar scaphoid plating by a single surgeon between 2013 and 2019. Patients were followed up for a minimum of 3 months with scaphoid bony union being confirmed on radiograph or computed tomography. Postoperative complications and need for plate removal were recorded. RESULTS Overall union rate of 96% with all 19 chronic nonunions demonstrating radiological union and 1 of 9 acute fractures not uniting and requiring revision surgery. The only postoperative complication identified was symptomatic plate impingement which necessitated plate removal in 57% of cases. CONCLUSIONS This case series demonstrates volar plating of scaphoid fractures can be used as an alternative technique to achieve union.
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Affiliation(s)
| | | | | | - Steve Csongvay
- The Alfred Hospital, Melbourne, Victoria, Australia
- Cabrini Hospital - Malvern, Melbourne, Victoria, Australia
- St John of God Ballarat Hospital, Victoria, Australia
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Becker J, Luria S, Huang S, Petchprapa C, Wollstein R. Wrist angle measurements in predicting the presence of a displaced scaphoid fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03418-5. [PMID: 36303041 DOI: 10.1007/s00590-022-03418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Early diagnosis and treatment of scaphoid fractures is critical to achieve union and prevent wrist degenerative arthritis. Plain radiographic measurements can guide the early approach to suspected fractures. Specifically, the ability to predict fracture or fracture stability from plain radiographs may allow the traumatologist to expand initial referral to three-dimensional imaging. We evaluated the ability of four measured angles to predict presence of a scaphoid fracture and stability. METHODS Fifty patients with a scaphoid fracture and 50 patients without fracture were evaluated for the cortical ring sign, scapho-lunate gapping, lateral scapholunate (SL), radio-scaphoid (RS), radio-lunate (RL), and radio-capitate (RC) angles by two-blinded observers. RESULTS Measurement of an increased SL interval was associated with the presence of a scaphoid fracture as diagnosed on three-dimensional imaging [odds ratio (OR) 3.0, confidence interval (CI) 1.53-5.87, p = < 0.01]. The measured RL angle was associated with fracture displacement (OR 1.13, 95% CI 1.02-1.25, p = 0.02). CONCLUSIONS Scapholunate gapping on plain radiographs in the context of a clinically suspected scaphoid fracture should increase suspicion for a fracture and may prompt earlier 3-dimensional imaging, while the presence of an abnormal radiolunate angle should increase wariness for instability and can be used in preoperative planning.
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Affiliation(s)
- Jacob Becker
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Shai Luria
- Hadassah Medical Center, Jerusalem, Israel
| | - Shengnan Huang
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Catherine Petchprapa
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA
| | - Ronit Wollstein
- School of Medicine, New York University, 1999 Marcus Ave., New Hyde Park, NY, 11042, USA.
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Abstract
The scaphoid is predisposed to nonunion after fracture because of its tenuous blood supply and propensity for delayed diagnosis. Many surgical techniques exist and continue to be developed to treat scaphoid non-unions. However, with variability in patient presentation, differences in nonunion location and type, and multiple bone graft sources and fixation options, selecting a surgical strategy proves a difficult task. The goal of this article is to provide an updated review of surgical strategies used to treat scaphoid nonunions. Particular attention is paid to methods of fixation as well as the ongoing debate over indications for structural and vascularized bone grafting. [Orthopedics. 2022;45(5):e235-e242.].
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Van Nest DS, Reynolds M, Warnick E, Sherman M, Ilyas AM. Volar Plating versus Headless Compression Screw Fixation of Scaphoid Nonunions: A Meta-analysis of Outcomes. J Wrist Surg 2021; 10:255-261. [PMID: 34109071 PMCID: PMC8169164 DOI: 10.1055/s-0040-1721405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Background Headless compression screw fixation with bone grafting has been the mainstay of treatment for scaphoid nonunion for the past several decades. Recently, locked volar plate fixation has gained popularity as a technique for scaphoid fixation, especially for recalcitrant or secondary nonunions. Purpose The purpose of this meta-analysis was to compare union rates and clinical outcomes between locked volar plate fixation and headless compression screw fixation for the treatment of scaphoid nonunions. Methods A literature search was performed for studies documenting treatment outcomes for scaphoid nonunions from 2000 to 2020. Inclusion criteria consisted of (1) average age > 18 years, (2) primary study using screw fixation, plate fixation, or both, with discrete data reported for each procedure, and (3) average follow-up of at least 3 months. Exclusion criteria consisted of studies with incomplete or missing data on union rates. Data from each study was weighted, combined within treatment groups, and compared across treatment groups using a generalized linear model or binomial distribution. Results Following title and full-text review, 23 articles were included for analysis. Preoperatively, patients treated with plate fixation had significantly longer time from injury to surgery and were more likely to have failed prior surgical intervention. There was no significant difference between union rates at 92 and 94% for screw and plate fixation, respectively. However, plate fixation resulted in longer time to union and lower modified Mayo wrist scores. Conclusion Patients treated with locked volar plate fixation were more likely to be used for recalcitrant or secondary nonunions. There was no statistically significant difference in union rates between screw and plate fixation. The results from this meta-analysis support the select use of locked volar plate fixation for scaphoid nonunion, especially recalcitrant nonunions and those that have failed prior surgical repair.
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Affiliation(s)
- Duncan S. Van Nest
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Reynolds
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eugene Warnick
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew Sherman
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Matić S, Vučković Č, Lešić A, Glišović Jovanović I, Polojac D, Dučić S, Bumbaširević M. Pedicled vascularized bone grafts compared with xenografts in the treatment of scaphoid nonunion. INTERNATIONAL ORTHOPAEDICS 2020; 45:1017-1023. [PMID: 32995916 DOI: 10.1007/s00264-020-04828-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Fractures of the scaphoid account for 60-70% of all wrist bone fractures. The results of treatment in terms of bone healing vary depending on the type and location of the fracture, the time elapsed since the injury, the type of surgical treatment. Nonunion occurs in 5-15% of the cases on average. The purpose of this paper is to compare the surgical techniques and results of treating scaphoid nonunion (SNU) with osteoplastic xenografts of bovine origin or a vascularized autograft of the distal part of the dorsal radius. METHODS We compare two groups of patients with symptomatic SNU, treated surgically with either a vascularized graft (n = 15) or a xenograft of bovine origin (n = 15). In the presurgical stage, the demographic characteristics of the patients, the time elapsed between injury and surgery, and classification of the injury (Schonberg, Herbert-Fisher, and Geissler-Slade) were recorded. One year following surgery, bone healing, total duration of the treatment, complications, the Mayo wrist score, and answers to the DASH questionnaire were analyzed. RESULTS No statistically significant differences between the two groups of patients were observed for bone healing (86.7% vs 80%) or functional results. A highly significant difference was observed with respect to duration of the surgical intervention in favor of xenografts. CONCLUSION The xenograft method is simple and relatively acceptable, providing good results in terms of healing and functionality.
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Affiliation(s)
- S Matić
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Č Vučković
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia
| | - A Lešić
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - I Glišović Jovanović
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia.
| | - D Polojac
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia
| | - S Dučić
- School of Medicine, University of Belgrade, Belgrade, Serbia.,University Children Hospital, Belgrade, Serbia
| | - M Bumbaširević
- Clinical Center of Serbia, Orthopedic and Traumatology University Clinic, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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Engel H, Xiong L, Heffinger C, Kneser U, Hirche C. Comparative outcome analysis of internal screw fixation and Kirschner wire fixation in the treatment of scaphoid nonunion. J Plast Reconstr Aesthet Surg 2020; 73:1675-1682. [PMID: 32473855 DOI: 10.1016/j.bjps.2020.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/21/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022]
Abstract
In cases with difficult scaphoid screw placement due to small, fragile bone fragments, or transplants and insufficient space, the internal Kirschner wire fixation is a fallback option; however, controversy remains regarding its stability, safety, and outcome. Between 2001 and 2011, 95 patients were treated in our center (n = 80 with cannulated compression screws and n = 15 with Kirschner wires), and retrospectively analyzed. The outcome measurements included the analysis of patient data, union rate and analysis of functional measures, and quality of life. Bony reconstructions were performed with Vascularized Bone Grafts (VBG) based on the 1,2-Intercompartmental Supraretinacular Artery (ICSRA) , Medial Femoral Condyle (MFC)-VBG, cancellous bone, and iliac crest grafts. Bony healing and functional outcome showed no significant differences between Kirschner wire fixation and cannulated compression screws, although significantly more 1,2-ICSRA-VBG were treated with Kirschner wires. Although predominantly used as an intraoperative fallback option, our data demonstrate that Kirschner wire internal fixation can be safe and reliable, with comparable bony union rates and excellent functional outcomes.
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Affiliation(s)
- Holger Engel
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Ethianum Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | - Lingyun Xiong
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Christian Heffinger
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Centre, BG Trauma Centre, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen/Rhine, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
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Mehling IM, Arsalan-Werner A, Wingenbach V, Seegmüller J, Schlageter M, Sauerbier M. Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 2019; 139:1161-1169. [PMID: 31123820 DOI: 10.1007/s00402-019-03196-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies. MATERIALS AND METHODS Between March 2010 and December 2014, 20 patients (age range 16-59 years) were treated with scaphoid locking plate osteosynthesis. In 17 cases it was due to scaphoid nonunion or delayed union and in three cases to treat a complex multi-fragmentary fracture of the scaphoid. Most of the initial fractures were located either in the proximal third (n = 9) or the middle third (n = 8) of the scaphoid. RESULTS Mean follow-up was 14.6 ± 8.9 months (range 2-30 months). All three scaphoid fractures (100%) showed bony healing in the CT scan after 2.7 ± 0.6 months. 15 of 17 (88.2%) patients with scaphoid nonunion demonstrated bony healing in the latest CT scan at an average of 6.2 ± 8.1 months (range 2-11 months) after scaphoid reconstruction. Range of motion (extension/flexion) was 104° ± 18.4° (range 80°-150°) and about one third less than the unaffected side. The average grip strength averaged 38.2 kg on the operated side and 44.1 kg on the unaffected side after surgery. 13 plates (65%) had to be removed due to impaction of the plate or protrusion of the screws. CONCLUSIONS This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.
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Affiliation(s)
- Isabella M Mehling
- Division for Hand Surgery, St. Vincent Hospital Hanau, Am Frankfurter Tor 19, 63450, Hanau, Germany.
| | - A Arsalan-Werner
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - V Wingenbach
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - J Seegmüller
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Schlageter
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Sauerbier
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
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Putnam JG, Mitchell SM, DiGiovanni RM, Stockwell EL, Edwards SG. Outcomes of Unstable Scaphoid Nonunion With Segmental Defect Treated With Plate Fixation and Autogenous Cancellous Graft. J Hand Surg Am 2019; 44:160.e1-160.e7. [PMID: 29958735 DOI: 10.1016/j.jhsa.2018.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Treatment of scaphoid nonunion with a segmental defect presents a challenging clinical problem. Various techniques have been proposed, often involving structural grafting with vascularized and nonvascularized bone. The authors hypothesize that satisfactory clinical and radiographic outcomes are possible with a relatively simplified technique of volar plate fixation with autogenous, purely cancellous graft. METHODS The authors performed a retrospective review of 34 patients with scaphoid nonunions with segmental defects, treated with plate fixation and purely cancellous bone grafting. Cases with avascular necrosis were excluded. Surgical management included a volar incision, reduction, bone grafting from the ipsilateral distal radius and/or olecranon, and application of a volar locking plate. Postoperative outcome measures included time to union based on computed tomography, return to work and sports, patient-reported pain and disability scores, grip strength, and range of motion. RESULTS Thirty-four patients with an average age of 31 years (range, 16-55 years) were treated with volar plate fixation and cancellous grafting, an average of 34 months after initial injury. Twenty-six patients (76%) were treated for nonunion at the scaphoid waist, 7 (21%) at the proximal pole, and 1 (3%) at the distal pole. Mean final follow-up was 18.7 months (range, 12-34 months). When union was defined by computed tomography evidence of healing, 2 (6%) scaphoids healed by 6 weeks after surgery, 28 (82%) healed by 12 weeks, and 100% healed by 18 weeks. Mean Disabilities of the Arm, Shoulder, and Hand score improved from 27.1 ± 7.3 before surgery to 11.8 ± 5.8 after surgery. Grip strength, corrected for hand dominance, improved from 77.5% of the nonsurgical side before surgery to 90.5% after surgery. All employed patients returned to work, although 3 (9%) did not return to full capacity. CONCLUSIONS The combination of scaphoid plate fixation and pure cancellous bone grafting for scaphoid nonunion with segmental defects yields reliable union rates and good patient outcomes. Autogenous cancellous grafting may be an alternative to more technically demanding or morbid grafting procedures for the treatment of scaphoid nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jill G Putnam
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ.
| | - Sean M Mitchell
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ
| | - Ryan M DiGiovanni
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ
| | - Erin L Stockwell
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ
| | - Scott G Edwards
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ
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