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Samade R, Awan HM. Surgical Treatment of Scaphoid Fractures: Recommendations for Management. J Wrist Surg 2024; 13:194-201. [PMID: 38808184 PMCID: PMC11129893 DOI: 10.1055/s-0043-1772689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/20/2023] [Indexed: 05/30/2024]
Abstract
Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: "scaphoid, "u8220"scaphoid" AND "nonunion, " and "scaphoid" AND "malunion. " Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV.
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Affiliation(s)
- Richard Samade
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hisham M. Awan
- Division of Hand and Upper Extremity Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Lee SH, Shin HD, Cha SM, Kim YK. Subchondral Radial and Ulnar K-Wire Positioning With Cancellous Bone Graft Shortens Union Time in Scaphoid Waist Nonunion. Ann Plast Surg 2024; 92:186-193. [PMID: 38170972 DOI: 10.1097/sap.0000000000003751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Bone grafting in patients with scaphoid waist nonunion can present several technical challenges. In this study, we aimed to present a modified surgical technique for scaphoid waist nonunion, which consisted of subchondral radial and ulnar K-wires positions with cancellous bone graft, and to compare the clinical outcome of this modified technique with the conventional method. METHODS We retrospectively reviewed 72 patients with scaphoid waist nonunion who had been surgically treated between January 2011 and December 2020. Of these, 34 patients were treated with the modified method and 38 with the conventional method. Debridement of the nonunion site was performed using a curette, rongeur, and microburr. Two or 3 K-wires were inserted along the cancellous portion of the scaphoid in the conventional method. In the modified method, 2 K-wires were inserted along the ulnar and radial subchondral portion of the scaphoid to increase the space for bone grafting in the cancellous portion of the scaphoid. The autologous cancellous bone grafted in both the methods. Demographic, radiological, and clinical outcomes were reviewed and compared between the groups. RESULTS There were no significant differences in demographics and characteristics of nonunion between the 2 groups of patients. The modified method group showed significantly shorter union time than the conventional method group (conventional group: 13.0 ± 1.3 weeks, modified group: 11.4 ± 1.1 weeks; P < 0.001). The bony union rate was 97.1% for the modified method and 89.5% for the conventional method. Satisfactory clinical outcomes (excellent and good Mayo wrist scores) were achieved in 27 cases (81.8%) using the modified method and 22 cases (64.7%) using the conventional method. CONCLUSION Subchondral radial and ulnar K-wire positioning with cancellous bone graft (modified method) can improve the union time with satisfactory clinical outcomes in the treatment of scaphoid waist nonunion.
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Affiliation(s)
- Seung Hoo Lee
- From the Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong-si
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University School of Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University School of Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Yun Ki Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University School of Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
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Rogers MJ, Ohlsen SM, Huang JI. Fixation Techniques for Scaphoid Nonunion. J Am Acad Orthop Surg 2023; 31:783-792. [PMID: 37307573 DOI: 10.5435/jaaos-d-23-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/18/2023] [Indexed: 06/14/2023] Open
Abstract
Scaphoid fractures are common injuries with high risk of nonunion. Various fixation techniques exist for managing scaphoid nonunions, including Kirschner wires, single or dual headless compression screws, combination fixation techniques, volar plating, and compressive staple fixation. The indication for each fixation technique varies depending on the patient, type of nonunion, and clinical scenario.
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Affiliation(s)
- Miranda J Rogers
- From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
- None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Rogers, Ohlsen, and Huang
| | - Suzanna M Ohlsen
- From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
- None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Rogers, Ohlsen, and Huang
| | - Jerry I Huang
- From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
- None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Rogers, Ohlsen, and Huang
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Gong H, Zhao G, Liu Y, Lu Z. Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskelet Disord 2022; 23:34. [PMID: 34986822 PMCID: PMC8734294 DOI: 10.1186/s12891-021-04977-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this prospective study was to assess the incidence of complex regional pain syndrome type I (CRPS I) in patients with scaphoid waist fracture and to explore associated factors. Methods This was a multicenter, prospective observational study. Demographic, imaging indicators and clinical data were collected before the conservative treatment of scaphoid waist fracture patients. The occurrence of CRPS I and pain condition were the main outcomes. To explore the factors associated with CRPS I, multivariate logistic regression model was used. Results A total of 493 scaphoid waist fracture participants undergoing conservative treatment were recruited for this study. The incidence of CRPS I was 20% (n = 87). The average time between injury and the onset of CRPS I was 6.7 ± 2.1 weeks. Multivariable logistic regression analysis revealed that female sex (odds ratio (OR): 1.669; 95% confidence interval (CI): 1.189–2.338), diabetes mellitus (OR: 3.206; 95% CI: 2.284–4.492), and severe pain condition before treatment (visual analog scale (VAS) score more than 4 cm) (OR: 27.966; 95% CI: 19.924–39.187) were independently associated with CRPS I. Conclusions Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. Early screening and regular follow up evaluation are recommended in these patients.
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Affiliation(s)
- Hao Gong
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.,Department of Medicine, Soochow University, Suzhou, China
| | - Gang Zhao
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Yuzhou Liu
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Zhengfeng Lu
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China.
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Muhammad Ali A, Adil M, Beg MSA, Ahmed OT. Comparison of Kirschner Wire Versus Screw Fixation in 1,2 Inter-Compartment Supra Retinaculum Artery Pedicle-Vascularized Bone Graft for Scaphoid Fractures. Cureus 2021; 13:e17533. [PMID: 34603900 PMCID: PMC8477263 DOI: 10.7759/cureus.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The purpose of the study was to compare the outcomes of the Kirschner wires (k-wires) versus screw fixation in 1,2 inter-compartment supra retinaculum artery (ICSRA) pedicle-vascularized bone graft for scaphoid non-union treatment. METHOD A retrospective study that included all patients with scaphoid nonunion underwent pedicle-vascularized bone graft and fixated with either k-wire or screw from 2010 through 2019 in the Department of Plastic and Reconstructive Surgery at Liaquat National Hospital and Medical College. Clinical outcomes were compared between k-wire and screw fixation, which were measured in terms of union rate, time of healing, pre and post-operative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion at wrist, and grip strength of hand. RESULTS A total of 33 patients were included in the study. All of them had scaphoid non-union and were treated with 1,2 ICSRA pedicle-vascularized bone graft; 20 patients had a fixation with k-wire and 13 with a screw. Radiological healing was achieved in 18 patients with k-wire and 11 patients with screw fixation, with healing rates of 90% and 84.6%, respectively. There was a significant decrease in DASH score postoperatively in both groups. Although no significant difference between the outcomes of both groups whether on union rate, DASH score, or range of motion at the wrist. CONCLUSION Hence, there is no significant difference in outcome between k-wire and screw fixation methods. We concluded k-wire as a more acceptable option with vascularized bone graft fixation as less technically demanding and low cost as compared to screw fixation.
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Affiliation(s)
- Asma Muhammad Ali
- Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Muhammad Adil
- Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Mirza Shehab A Beg
- Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Osama T Ahmed
- Plastic and Reconstructive Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
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Rancy SK, Wolfe SW, Jerome JTJ. Predictors of Failure for Vascularized and Nonvascularized Bone Grafting of Scaphoid Nonunions: A Systematic Review. J Hand Microsurg 2021; 14:322-335. [DOI: 10.1055/s-0041-1735349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objective This article compares predictors of failure for vascularized (VBG) and nonvascularized bone grafting (NVBG) of scaphoid nonunions.
Methods We conducted a systematic literature review of outcomes after VBG and NVBG of scaphoid nonunion. Fifty-one VBG studies (N = 1,419 patients) and 81 NVBG studies (N = 3,019 patients) met the inclusion criteria. Data were collected on surgical technique, type of fixation, time from injury to surgery, fracture location, abnormal carpal posture (humpback deformity and/or dorsal intercalated segmental instability [DISI]), radiographic parameters of carpal alignment, prior failed surgery, smoking status, and avascular necrosis (AVN) as defined by punctate bleeding, magnetic resonance imaging (MRI) with contrast, MRI without contrast, X-ray, and histology. Meta-analysis of proportions was conducted with Freeman–Tukey double arcsine transformation. Multilevel mixed-effects analyses were performed with univariable and multivariable Poisson regression to identify confounders and evaluate predictors of failure.
Results The pooled failure incidence effect size was comparable between VBG and NVBG (0.09 [95% confidence interval [CI] 0.05–0.13] and 0.08 [95% CI 0.06–0.11], respectively). Humpback deformity and/or DISI (incidence-rate radios [IRRs] 1.57, CI: 1.04–2.36) and lateral intrascaphoid angle (IRR 1.21, CI: 1.08–1.37) were significantly associated with an increased VBG failure incidence. Time from injury to surgery (IRR 1.09, CI: 1.06–1.12) and height-to-length (H/L) ratio (IRR 53.98, CI: 1.16–2,504.24) were significantly associated with an increased NVBG failure incidence, though H/L ratio demonstrated a wide CI. Decreased proximal fragment contrast uptake on MRI was a statistically significant predictor of increased failure incidence for both VBG (IRR 2.03 CI: 1.13–3.66) and NVBG (IRR 1.39, CI: 1.16–1.66). Punctate bleeding or radiographic AVN, scapholunate angle, radiolunate angle, and prior failed surgery were not associated with failure incidence for either bone graft type (p > 0.05).
Conclusion Humpback deformity and/or DISI and increasing lateral intrascaphoid angle may be predictors of VBG failure. Time from injury to surgery may be a predictor of NVBG failure. AVN as defined by decreased contrast uptake on MRI may be a marker of increased failure risk for both bone graft types.
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Affiliation(s)
- Schneider K. Rancy
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Scott W. Wolfe
- Division of Hand and Upper Extremity, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, United States
| | - J. Terrence Jose Jerome
- Department of Orthopedics, Hand & Reconstructive Microsurgery, Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India
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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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