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Noble DM, Dacus AR, Chhabra AB. Advances in the Treatment of Hand and Wrist Injuries in the Elite Athlete. J Hand Surg Am 2024; 49:779-787. [PMID: 38775759 DOI: 10.1016/j.jhsa.2024.03.018] [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] [Received: 08/16/2023] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 08/05/2024]
Abstract
Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete.
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Affiliation(s)
- David Matthew Noble
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Angelo Rashard Dacus
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA
| | - Abhinav Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA.
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Kang A, Lee H, Lee A, Roh Y, Sim B, Jeong J. Biomechanical Comparison of Double 2.3-mm Headless Cannulated Self-Compression Screws and Single 3.5-mm Cortical Screw in Lag Fashion in a Canine Sacroiliac Luxation Model: A Small Dog Cadaveric Study. Vet Comp Orthop Traumatol 2024; 37:13-22. [PMID: 37562428 PMCID: PMC10789505 DOI: 10.1055/s-0043-1771508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility of safe positioning of double 2.3-mm headless cannulated self-compression screws (HCS) in a small dog cadaveric sacroiliac luxation model and to compare the static rotational biomechanical properties of fixation repaired using two different screw systems with a minimally invasive osteosynthesis technique: double 2.3-mm HCS and a single 3.5-mm standard cortical screw placed in a lag fashion. STUDY DESIGN A unilateral small dog sacroiliac luxation model was stabilized using double 2.3-mm HCS (n = 11) or a single 3.5-mm cortical screw (n = 11). Radiographic and computed tomography (CT) imaging analyses and biomechanical testing of rotational force on the sacroiliac joint of both fixations were performed. The maximum load at failure and failure modes of each fixation were recorded and compared. RESULTS Fluoroscopically guided percutaneous application of double HCS was safe in a unilateral sacroiliac luxation model in small dogs without violation of the vertebral and ventral sacral foramen. Furthermore, resistance to rotational force applied on fixation of the sacroiliac joint repaired with double 2.3-mm HCS estimated by maximum failure load was significantly higher than that of a single 3.5-mm cortical screw (p < 0.001). CONCLUSION Although this was an experimental cadaveric study, based on our results, the use of smaller double HCS may be beneficial as an alternative to the conventional single lag screw for stabilization of sacroiliac luxation in small dogs.
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Affiliation(s)
- AhRan Kang
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Haebeom Lee
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Arim Lee
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
| | - Yoonho Roh
- Division of Animal Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Bokyun Sim
- Graduate Program of Biomedical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jaemin Jeong
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, Republic of Korea
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DiPrinzio EV, Dieterich JD, Walsh AL, Warburton AJ, Chang AL, Hausman MR, Kim JM. Two Parallel Headless Compression Screws for Scaphoid Fractures: Radiographic Analysis and Preliminary Outcome. Hand (N Y) 2023; 18:1267-1274. [PMID: 35403458 PMCID: PMC10617477 DOI: 10.1177/15589447221081879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite surgical fixation, the scaphoid nonunion rate remains at 3% to 5%. Recent biomechanical studies have demonstrated increased stability with 2-screw constructs. The objective of our study is to determine the preliminary union rate and anatomic feasibility of 2-screw surgical fixation for scaphoid fractures. METHODS This study is a retrospective case series of 25 patients (average age 32 years) with scaphoid fractures treated with 2 parallel headless compression screws (HCS). Postoperative evaluation included Mayo Wrist Score (MWS), range of motion, time to union, and return to activity. Bivariate analysis for gender and Pearson correlation coefficient for body size (height, weight, and body mass index) was conducted against radiographically measured scaphoid width, screw lengths, and the distance between the 2 screws. RESULTS All fractures healed with an average time to union of 9.9 weeks (median 7.6 weeks; range: 4.1-28.3). The mean MWS was 93.3 (range: 55-100), with 3 complications (12%), one of which affected the outcome of the surgery. The bivariate analysis demonstrated that the female gender was associated with significantly smaller scaphoid width (P = .004) but a similar distance between the 2 screws (P = .281). The distance between the 2 screws and the body size demonstrated a weak-to-no correlation. CONCLUSIONS The 2-screw construct for scaphoid fracture achieved a favorable union rate and clinical outcome. Gender was the only variable significantly associated with scaphoid width and screw length. The distance between the screws was constant regardless of gender and body size, indicating that the technique for parallel screw placement can remain consistent. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | | | | | - Andy L. Chang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jaehon M. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Putnam J. Rethinking Scaphoid Fixation. Hand Clin 2023; 39:597-604. [PMID: 37827612 DOI: 10.1016/j.hcl.2023.05.007] [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: 10/14/2023]
Abstract
Scaphoid fixation, whether for acute injuries or nonunion, is made challenging by the small and intra-articular nature of the most commonly fractured carpal bone. The purpose of this article is to review the techniques to simplify scaphoid fixation and to optimize healing and early return to activity.
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Affiliation(s)
- Jill Putnam
- The Hand and Upper Extremity Center, The Ohio State University, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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Gray RRL, Halpern AL, King SR, Anderson JE. Scaphoid fracture and nonunion: new directions. J Hand Surg Eur Vol 2023; 48:4S-10S. [PMID: 37704024 DOI: 10.1177/17531934231165419] [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: 09/15/2023]
Abstract
The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.
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Affiliation(s)
- Robert R L Gray
- NorthShore Department of Orthopaedic Surgery, Chicago, IL, USA
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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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Quadlbauer S, Pezzei C, Jurkowitsch J, Beer T, Moser V, Rosenauer R, Salminger S, Hausner T, Leixnering M. Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperative extracorporeal shockwave therapy (ESWT). Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04806-0. [PMID: 36808564 DOI: 10.1007/s00402-023-04806-0] [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: 12/04/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. MATERIALS AND METHODS Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41 mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. RESULTS Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant. However, at a mean follow-up interval of 34 months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. CONCLUSIONS Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - V Moser
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S Salminger
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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Cheng C, Jiang Z, Sun H, Hu J, Ouyang Y. Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft. J Orthop Surg Res 2023; 18:52. [PMID: 36653796 PMCID: PMC9847075 DOI: 10.1186/s13018-023-03529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment. PURPOSE This study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes. METHODS It was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period. RESULTS Significant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients. CONCLUSIONS The arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.
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Affiliation(s)
- Cong Cheng
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Zongyuan Jiang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Haoran Sun
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Jiaping Hu
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
| | - Yanggang Ouyang
- grid.284723.80000 0000 8877 7471Department of Hand Surgery, Affiliated Longhua People’s Hospital, Southern Medical University, Shenzhen, 518000 China
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Dittman LE, Kakar S. CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain. Hand Clin 2022; 38:149-160. [PMID: 35465933 DOI: 10.1016/j.hcl.2022.01.001] [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] [Indexed: 02/02/2023]
Abstract
In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.
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Affiliation(s)
| | - Sanjeev Kakar
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Sharpe FE, McCarty CP, Goo C, Kim N, Park SH, Ebramzadeh E. Cross-Sectional Areas and Volumes Occupied by Implants in Simulated Scaphoid Fractures. J Hand Surg Am 2022; 47:228-236. [PMID: 34887135 DOI: 10.1016/j.jhsa.2021.10.019] [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: 02/22/2021] [Revised: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE This study determined the volume of bone replaced by an implant at the proximal and distal poles of simulated scaphoid fractures. We also measured the cross-sectional area of the implant relative to the cross-sectional area of the scaphoid at 2 different simulated fracture locations. METHODS Microcomputed tomograhy scans of 7 cadaveric scaphoids were used to create 3-dimensional models in which transverse proximal pole and midwaist fractures were simulated. The volume occupied by 5 commonly used implants and the cross-sectional area occupied at the surface of the fractures was measured using a computer modeling software. RESULTS For simulated proximal pole fractures, the implants replaced 1.5%-7.4% of the fracture cross-sectional area and 1.2%-6.4% of the proximal fragment bone volume. For midwaist fractures, the implants replaced 1.5%-6.8% of the fracture cross-sectional area and 1.8%-4.6% of the proximal pole volume. Although the different implant designs replaced different areas and volumes, all these differences were small and below 4%. CONCLUSIONS This study provides data that relate to one aspect of fracture healing, specifically, the surface area occupied by 5 different implants in proximal and midwaist scaphoid fractures as well as the volume of bone replaced by the implant. CLINICAL RELEVANCE As opposed to the impression provided by 2-dimensional planar imaging, when studied using a 3-dimensional model, the volume and surface area replaced by an implant represent a minimal percentage of scaphoid bone, suggesting a negligible clinical effect.
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Affiliation(s)
- Frances E Sharpe
- Department of Hand and Orthopedic Surgery, Southern California Permanente Medical Group, Fontana Medical Center, Fontana, CA; Department of Orthopedic Surgery University of Southern California Keck School of Medicine, Fontana Medical Center, Fontana, CA.
| | - Colin P McCarty
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Connor Goo
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Nicolas Kim
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Sang-Hyun Park
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children and UCLA Department of Orthopaedic Surgery, Los Angeles, CA
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Zhang X, Wang L, Ma X, Wang F, Duan W, Shao X. Cannulated compression screw with versus without two K-wire fixation for treatment of scaphoid waist fracture nonunion. J Orthop Surg Res 2022; 17:78. [PMID: 35123519 PMCID: PMC8818197 DOI: 10.1186/s13018-022-02975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022] Open
Abstract
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.
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Fyllos A, Komnos G, Koutis A, Bargiotas K, Varitimidis S, Dailiana Z. Comparison of Minimally Invasive Operative Treatment with Conservative Treatment for Acute, Minimally Displaced Scaphoid Fractures at 12 Months' Follow-up. J Wrist Surg 2021; 10:216-223. [PMID: 34109064 PMCID: PMC8169166 DOI: 10.1055/s-0040-1722333] [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: 07/04/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
Background Minimally displaced scaphoid fractures can be challenging to diagnose and treat. Cannulated scaphoid screws have made percutaneous stabilization highly effective. Questions Would minimally invasive operative treatment of minimally displaced scaphoid fractures yield faster return to work when compared with patients treated conservatively? How do functional and patient satisfaction scores compare between the two groups at 12-months follow-up? Patients and Methods Records from 18 patients (mean age 28.6 years) treated surgically were retrospectively reviewed and compared with a group of 10 patients (mean age 33.3 years, p = 0.74) treated nonoperatively. Inclusion criteria were a minimum follow-up period of 12 months and radiographic union. Time to return to work was compared between groups. At 12 months' follow-up, wrist range of motion (ROM) and grip strength were compared, as well as pain, satisfaction, and overall wrist function were evaluated by the visual analogue scale (VAS) and the Mayo modified wrist score (MMWS). Results The mean time to return to work for the operated group was 39.75 days, while for the nonoperated group it was 88.14 days ( p = 0.002). At the 12 months' follow-up, mean ROM, grip strength, and VAS score did not differ between groups. The mean MMWS was 98.75 for the operated group and 87.5 for the nonoperated group, indicating a better result in patients treated operatively ( p = 0.03). In addition, two failures of instrumentation were recorded, a seldom seen complication. Conclusion Percutaneous fixation of minimally displaced scaphoid fractures allows faster return to work and leaves patients more satisfied with their wrist function compared with plaster immobilization at 12 months' follow-up. Level of evidence This is a Level III, retrospective, case-control study.
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Affiliation(s)
- Apostolos Fyllos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - George Komnos
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Athanasios Koutis
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Konstantinos Bargiotas
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
| | - Zoe Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Biopolis, Larissa, Greece
- Department of Hand, Upper Extremity and Microsurgery, IASO Thessalias, Nikaia, Larissa, Greece
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Kaiser P, Brueckner G, Kastenberger T, Schmidle G, Stock K, Arora R. Mid-term follow-up of surgically treated and healed scaphoid fractures. HAND SURGERY & REHABILITATION 2021; 40:288-292. [PMID: 33549698 DOI: 10.1016/j.hansur.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the mid-term results of surgically treated scaphoid fractures since we were concerned that good results might deteriorate over time due to osteoarthritis or functional impairment. Thirty-three out of 121 surgically treated patients (isolated scaphoid fractures n = 23; scaphoid fractures with concomitant injuries n = 10) were evaluated retrospectively (47-138 months). Five patients (4%) had a non-union after internal fixation and were excluded because of additional treatment. The remaining 83 patients were not available for a follow-up examination. Patients with an isolated scaphoid fracture had a mean extension-flexion of 68°-0°-64°, a radial-ulnar deviation of 27°-0°-41° and a grip strength of 39 kg (corresponding to 87-98% of the uninjured contralateral wrist), while patients with concomitant injuries had a mean extension-flexion of 60°-0°-44°, radial-ulnar deviation of 22°-0°-38° and a grip strength of 42 kg (corresponding to 73-98% of the uninjured contralateral wrist). The Michigan Hand Questionnaire score was 85 and 75 and the Patient-Rated Wrist Evaluation score was 8 and 21, respectively. Fifteen patients had radiological signs of radiocarpal osteoarthritis with a significantly higher occurrence in those who had concomitant injuries compared to those with isolated scaphoid fractures (p < 0.01). There was no significant group difference in scaphotrapeziotrapezoid (STT) osteoarthritis (p = 0.968). One STT osteoarthritis case occurred after plate fixation, one after antegrade screw fixation and 10 after retrograde screw fixation. Surgical treatment of an acute isolated scaphoid fracture has excellent clinical, functional, and radiologic mid-term results, while scaphoid fractures with concomitant wrist injuries have slightly inferior results.
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Affiliation(s)
- P Kaiser
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Brueckner
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - T Kastenberger
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - G Schmidle
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - K Stock
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
| | - R Arora
- Department for Orthopaedics and Traumatology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
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14
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Hong J, Choi YR, Koh IH, Oh WT, Shin J, Kang HJ. Headless screw fixation through the dorsal rough surface for proximal-pole scaphoid-nonunion: a report of 15 patients. J Hand Surg Eur Vol 2020; 45:965-973. [PMID: 32009496 DOI: 10.1177/1753193420903672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clinical outcomes of the dorsal-retrograde headless screw-fixation technique in 15 patients with proximal scaphoid nonunion are presented. In this technique, screws are inserted from the dorsal rough surface of the scaphoid, located between the dorsal ridge and scaphoid-trapezium-trapezoid joint. Fifteen patients underwent osteosynthesis with this technique with iliac bone graft. Seven patients required primary surgery, and eight patients with a history of failed operation required revision surgery. Among 15 patients, 13 achieved union and two with persistent nonunion were asymptomatic with average follow-up of 24 months (range 14-57). Mean time to union was 20 weeks (range 12-40). Our experience with the dorsal-retrograde headless screw fixation technique has shown encouraging results for the treatment of proximal-scaphoid nonunion, especially in revision surgery wherein secure fixation of the small proximal fragments can be difficult using conventional anterograde techniques.Level of evidence: IV.
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Affiliation(s)
- JungJun Hong
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jucheol Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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15
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Single versus double screw fixation for the treatment of scaphoid waist fractures: Finite element analysis and preliminary clinical results in scaphoid nonunion. Jt Dis Relat Surg 2020; 31:73-80. [PMID: 32160498 PMCID: PMC7489128 DOI: 10.5606/ehc.2020.71521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives
This study aims to compare the single versus double screw fixation of scaphoid waist fractures using finite element analysis, and to present the preliminary clinical results of double screw fixation in a consecutive series of patients with scaphoid nonunion. Patients and methods
A transverse scaphoid waist fracture (Herbert type B2) model was fixed with either single or double cannulated compression screws. Displacement and rotation of the fragments were performed using three-dimensional finite element analysis in three different wrist positions. A retrospective review was performed on 13 male patients (mean age 31.6±12.8 years; range, 17 to 64 years) who underwent double screw fixation for an established scaphoid nonunion in our clinic between January 2015 and December 2017. Assessment of union was established with serial plain radiographs in eight patients and with wrist computed tomography in five patients. Clinical evaluation was performed using the Mayo wrist score and visual analog scale (VAS). Results
In all wrist positions, the displacement of the fracture gap in double screw fixation in all planes (x, y, and z) was less than in single screw fixation. Similarly, rotation of the fracture fragments around the longitudinal axis of the scaphoid was lower in double screw fixation. Complete union was obtained in all patients. The mean time to union was 5±0.75 months (range, 4 to 6 months). The mean VAS was 0.8±0.9 (range, 0 to 3). Mayo wrist score was 91±6.9 (range, 80 to 100) at the final follow-up. Conclusion Double-screw fixation technique may be a solution to reduce the rate of scaphoid nonunion in unstable type B2 scaphoid fractures or nonunion.
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16
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Two-Screw Fixation of Scaphoid Waist Fractures. J Hand Surg Am 2020; 45:783.e1-783.e4. [PMID: 32327338 DOI: 10.1016/j.jhsa.2020.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 02/03/2020] [Accepted: 03/04/2020] [Indexed: 02/02/2023]
Abstract
Optimal fixation strategy for scaphoid waist fractures remains a contentious topic with options including using a single screw, 2 screws, or a scaphoid plate. Biomechanical studies favor 2-screw fixation with regards to higher load to failure, load to 2-mm displacement, energy absorbed, rotational stability, and stiffness. Furthermore, recent retrospective studies found increased union rate with 2 screws. Although conclusive clinical data are lacking, 2-screw fixation of a scaphoid waist fracture may theoretically allow the patient to start earlier range of motion and strengthening with greater confidence. Our experience with 2-screw fixation has been promising with all acute waist fractures healing and nonunions treated with 2 screws having high union and low reoperation rates.
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17
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Ansari SA, Kennedy JA, Younis F. Postoperative Outcomes of Volar Plate Fixation in Cases of Scaphoid Deformity or Nonunion: A Case Series. J Wrist Surg 2020; 9:304-311. [PMID: 32760609 PMCID: PMC7395847 DOI: 10.1055/s-0040-1710383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Background Fractures through the waist of scaphoid are a common injury, resulting in deformity or nonunion. Recently, a locking plate has been shown to fix deformity or nonunion of scaphoid, with limited observation of functional postoperative outcomes. Objectives We present a case series of 16 patients, with the disabilities of the arm, shoulder, and hand (DASH) score evaluation in primary fixation of scaphoid fractures with humpback deformity ( n = 11) and revision open reduction internal fixation (ORIF) for nonunion ( n = 5), using the Medartis TriLock 1.5 scaphoid plate and bone grafting. Patients and Methods DASH scores were obtained preoperatively and postoperatively at 3, 6, and 12 (if required) months. Patient demographics, smoking status, employment type, and grip strengths were recorded. Results Thirteen patients attended follow-up. Union was clinically and radiologically assessed with 13 achieving union. The mean preoperative DASH score was 34.0 ( n = 16) and at treatment completion (discharge or DNA) was 11.5 ( n = 13), with mean reduction of 18.5 ( p = 0.03). At treatment completion, mean reduction in DASH score of revision ORIF was 13.7 ( p = 0.27; n = 4), compared with 20.7 ( p < 0.01; n = 9) in primary fixation with plate. Conclusions Deformity correction, reduction in DASH score, and rate of union make the plate system useful in the management of scaphoid fractures with humpback deformity and revision for nonunion. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Saif A. Ansari
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - James A. Kennedy
- Department of Trauma and Orthopaedics, Health Education North West ST6 Trauma and Orthopaedics, Health Education North West, Lancashire, United Kingdom
| | - Fizan Younis
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
- Department of Hand Surgery, University of Central Lancashire, East Lancashire Hospitals National Health Service Trust, Lancashire, United Kingdom
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18
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Eng K, Gill S, Hoy S, Shridar V, Van Zyl N, Page R. Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study. J Wrist Surg 2020; 9:225-229. [PMID: 32509427 PMCID: PMC7263855 DOI: 10.1055/s-0040-1702199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13-46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0-42) and mean PRWE was 11 (range 0-54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.
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Affiliation(s)
- Kevin Eng
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Stephen Gill
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Simon Hoy
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Vivek Shridar
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Natasha Van Zyl
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Richard Page
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
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19
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van Rijckevorsel VA, Selles CA, van der Vlies CH, Cleffken BI, Schep NW. Functional Outcome following Headless Compression Screw Fixation for Hamate Fractures. J Wrist Surg 2020; 9:164-169. [PMID: 32257620 PMCID: PMC7113013 DOI: 10.1055/s-0039-1695765] [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: 03/18/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Hamate fractures can be treated nonoperatively, with the percutaneous Kirschner wire (K-wire) fixation, or with excision of a fractured hook of the hamate. Screw fixation is less popular owing to the risk of iatrogenic ulnar nerve injury. The aim of this study was to present the functional results of patients with hamate fractures treated with headless compression screws (HCS). The primary outcome was the Michigan Hand Outcome Questionnaire (MHOQ) after at least 4 months of follow-up. Nine patients were included in this retrospective cohort study. A median MHOQ total score of 67% was reported (interquartile range [IQR]: 44-76). No complications were found during follow-up. HCS fixation is a safe alternative to treat hamate fractures with good functional outcome. This is a Level IV study.
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Affiliation(s)
| | - Caroline A. Selles
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Berry I. Cleffken
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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20
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Graul I, Lindner R, Schettler N, Friedel R, Hofmann GO. Deviations in positioning variable pitch screws- scaphoid waist fractures. Orthop Traumatol Surg Res 2020; 106:347-351. [PMID: 31899116 DOI: 10.1016/j.otsr.2019.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/10/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Operative therapy using a headless cannulated variable pitch compression screw is the gold standard for the treatment of instable scaphoid fractures. HYPOTHESIS Deviation from the central placement is associated with a loss of stability and stiffness. MATERIAL AND METHODS An artificial bone model was manufactured and different screw positions (central, 10° and 20° to the long axis) were assessed. A shearing test with axial force on the 45° flexed scaphoid was applied. RESULTS The inserted variable pitch screw showed the highest stiffness and failure force in a position in the long axis. At 10 degrees, a slight decrease in stiffness (32.7N/mm±9.3N/mm) and failure force (41.6N±13.2N) was observed, while a significant reduction in stiffness (29.3N/mm±4.6N/mm) and failure force (50.3N±19.5N) was measured at 20 degrees. DISCUSSION Deviations in the angle of insertion of the compression screw cause loss in failure force, thus deviations from the central placement is associated with less stability and stiffness. LEVEL OF PROOF Controlled laboratory study (basic science study, biomechanical testing).
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Affiliation(s)
- Isabel Graul
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany.
| | - Robert Lindner
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany
| | - Nicky Schettler
- Department of Trauma, Orthopedics and hand surgery, Helios Erfurt, Germany
| | - Reinhard Friedel
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany
| | - Gunther O Hofmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Jena, Germany; Department of Trauma, BG Bergmanstrost, Halle, Germany
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21
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Retrograde Intramedullary Absorbable Pin Fixation for Intraarticular Fracture of the Metacarpal Head. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Quadlbauer S, Pezzei C, Jurkowitsch J, Krimmer H, Sauerbier M, Hausner T, Leixnering M. Palmare winkelstabile Verplattung von Pseudarthrosen und Trümmerfrakturen des Kahnbeins. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:433-446. [DOI: 10.1007/s00064-019-00623-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
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23
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Abstract
Most minimally displaced scaphoid fractures and all displaced scaphoid fractures in elite athletes are treated with early fixation to maximally expedite the return to full function. Computed tomographic (CT) scans are recommended in all scaphoid fractures to facilitate a complete understanding of fracture anatomy and to allow for optimal screw placement. Screw placement is important to maximize healing capacity of the fracture and allow for return to sport. Postoperative CT scans can be helpful to evaluate the extent of healing and may allow patients to return to play sooner.
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Affiliation(s)
- Edward W Jernigan
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
| | - Kyle W Morse
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA.
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, FL 4, New York, NY 10021, USA
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24
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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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25
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Quadlbauer S, Pezzei C, Beer T, Jurkowitsch J, Keuchel T, Schlintner C, Schaden W, Hausner T, Leixnering M. Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg 2019; 139:281-293. [PMID: 30523445 DOI: 10.1007/s00402-018-3087-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Scaphoid nonunion remains challenging for hand surgeons. Several treatment options are available such as: non-vascularized or vascularized bone grafting, with or without additional stabilization. In the last few decades, extracorporeal shockwave therapy (ESWT) has become an established procedure for treating delayed and nonunions. Purpose of this retrospective follow-up study was (a) to investigate union rate and clinical outcome of the different implants [either one/two headless compression screws (HCS) or a plate] and (b) union rate and clinical outcome using only surgery, or a combination of surgery and ESWT. MATERIALS AND METHODS The study included 42 patients with scaphoid nonunions of the waist with a mean follow-up of 52 months. All patients received a non-vascularized bone graft from the iliac crest and stabilization was achieved by using one, two HCS or a plate. ESWT was performed with 3000 impulses, energy flux density per pulse 0.41 mJ/mm2 within 2 weeks after surgery. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, Disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. In addition, each patient had a CT scan of the wrist. RESULTS A total of 33/42 (79%) patients showed union at the follow-up investigation. Patients treated with additional ESWT showed bony healing in 21/26 (81%) and without ESWT in 12/16 (75%). Patients that were stabilized using one HCS showed bony healing in 6/10 (60%), with two HCS 10/12 (83%) and by plate 17/20 (85%). The ESWT group had a significantly lower pain score according to the VAS and better modified Green O'Brien (Mayo) Score. No differences could be found in respect of ROM, grip strength, functional outcome score depending of which stabilization method was used. CONCLUSIONS Stabilization of scaphoid waist nonunions with two HCS or plate showed higher union rates than a stabilization using only one HCS. In addition, ESWT combined with a nonvascularized bone graft from the iliac crest seems a suitable option for treating scaphoid nonunions.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Keuchel
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - C Schlintner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - W Schaden
- AUVA Trauma Hospital Meidling - European Hand Trauma Center, Kundratstraße 37, 1120, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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26
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Meszaros T, Vögelin E, Mathys L, Leclère FM. Perilunate fracture-dislocations: clinical and radiological results of 21 cases. Arch Orthop Trauma Surg 2018; 138:287-297. [PMID: 29282524 DOI: 10.1007/s00402-017-2861-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Perilunate dislocations and fracture-dislocations are a subcategory of the carpal instability complex. Herein, we report our university hospital experience with this complex injury. The goal of our study was to find predictive factors and quantify the development of arthritis and lunate necrosis. We tried to measure the impact of arthritis on hand function. METHODS Between January 2000 and December 2014, 21 patients underwent surgery for perilunate dislocations and perilunate fracture-dislocations of the wrist in our tertiary university center. Mean patient age was 29.3 ± 10.0 years (range 18-49 years). All displacements were posterior. They were reviewed both clinically and radiologically. RESULTS Complications included misdiagnosed Essex-Lopresti-like lesion in one case, insufficient reposition of the carpus in two cases (LT in one case, SL in one case), and iatrogenic injury to the radial artery immediately sutured in one case. All 3 cases underwent a second procedure with satisfactory outcome. After a mean follow-up of 112 ± 60 months (range 12-210 months), the average Cooney score was 80 ± 19 (range 50-125). The mean PRWE score was 10 ± 8 (range 0-25). The mean DASH score was 40 ± 13 (range 30-75 months). Mean pain on load, measured with VAS was 1.1 ± 1.6; Clinical examination assessed a mean wrist extension/flexion of 42.4° ± 17.2°/48.4° ± 15.2°. Mean wrist ulnar/radial deviation was, respectively, 22.9° ± 11.3°/15.3° ± 7.0°. Mean pro/supination was, respectively, 75.2° ± 11.5°/76.3° ± 8.1°. Mean pinch strength was 9.4 ± 2.2 kg (87.4 ± 17.7% of the contralateral side). Mean power strength was 41.9 ± 9.9 kg (76.2 ± 19.2% of the contralateral side). Two patients had a scaphoid non-union identified on their most recent imaging. The mean carpal height ratio was 0.53 ± 0.05 (range 0.44-0.65). All except one patient developed arthritis: Grade 1 in 11 patients, Grade 2 in 3 patients, and Grade 3 in the remaining 6 patients. Age, length of follow-up, and loss of reduction were significantly associated with wrist arthritis (p < 0.001). Lunate avascular necrosis assessed by magnetic resonance imaging was present in 6 patients: Stage 2 in 4 patients, Stage 3a in 1 patient, and Stage 3b in the remaining patient. All these patients' intraoperative findings showed lesion of the cartilage of the radial side of the lunate. However, the small number of patients who developed lunate necrosis did not allow satisfactory statistical analysis. CONCLUSIONS This retrospective study demonstrates good functional results despite the high rate of radiological wrist arthritis. Age, length of follow-up, and loss of reduction were significantly associated with wrist arthritis in our series.
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Affiliation(s)
- Thomas Meszaros
- Department of Hand and Plastic Surgery, INSELSPITAL Bern and University of Bern, Freiburgstrasse, 8, 3010, Bern, Switzerland
| | - Esther Vögelin
- Department of Hand and Plastic Surgery, INSELSPITAL Bern and University of Bern, Freiburgstrasse, 8, 3010, Bern, Switzerland
| | - Lukas Mathys
- Department of Hand and Plastic Surgery, INSELSPITAL Bern and University of Bern, Freiburgstrasse, 8, 3010, Bern, Switzerland
| | - Franck Marie Leclère
- Department of Hand and Plastic Surgery, INSELSPITAL Bern and University of Bern, Freiburgstrasse, 8, 3010, Bern, Switzerland.
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Schmidle G, Ebner HL, Klauser AS, Fritz J, Arora R, Gabl M. Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery. Arch Orthop Trauma Surg 2018; 138:1395-1405. [PMID: 30006666 PMCID: PMC6132950 DOI: 10.1007/s00402-018-2983-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION For the treatment of scaphoid non-unions (SNU), different surgical techniques, including vascularized and non-vascularized bone grafts, are applied. Besides stability, vascularity, and the biological situation at the non-union site are important for healing and the appropriate choice of treatment. We assessed the healing potential of SNUs by histological parameters and compared it to CT parameters of bone structure and fracture location. Based on the results, we developed a CT classification and a treatment algorithm to impact graft selection in SNU surgery. PATIENTS AND METHODS Preoperative 2D-CT reformations of 29 patients were analyzed for trabecular structure, sclerosis, and fragmentation of the proximal fragment. The fracture location was assessed on 3D-CT reconstructions and grouped in three zones depending on the potential blood supply. Samples were taken during surgery for histological evaluation. Histological parameters of bone healing were defined and a bone healing capacity score (BHC), reflecting histological bone viability, was calculated. CT findings were compared to BHC, age of SNU, and time to union. RESULTS Cases with trabecular structure and without fragmentation showed a statistically significant higher BHC. Time to union was significantly faster if trabecular structure was present and sclerosis was absent. In intraarticular proximal pole non-unions, where no blood supply is assumed, the BHC was statistically significantly lower and time to union was longer compared to SNUs of the other locations. A statistically significant correlation between BHC and time to union was found in the proximal and distal fragment with higher BHC associated with faster healing. CONCLUSIONS CT parameters of bone structure and fracture location can reflect histological healing capacity of SNUs. This can guide bone graft selection in SNU surgery.
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Affiliation(s)
- Gernot Schmidle
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Hannes Leonhard Ebner
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Andrea Sabine Klauser
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Schöpfstraße 41, 6020, Innsbruck, Austria
| | - Rohit Arora
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Markus Gabl
- Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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