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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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Mickley JP, Lynch DJ, Gordon AM, Roebke AJ, Goyal KS. Fracture Gap Closure and Reduction Are Affected by the Orientation of the Headless Compression Screw. Hand (N Y) 2024; 19:656-663. [PMID: 36692082 PMCID: PMC11141410 DOI: 10.1177/15589447221150504] [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: 01/25/2023]
Abstract
BACKGROUND We evaluated the impact of a variable-pitch headless screw's angle of insertion relative to the fracture plane on fracture gap closure and reduction. METHODS Variable-pitch, fully threaded headless screws were inserted into polyurethane blocks of "normal" bone model density using a custom jig. Separate trials were completed with a 28-mm screw placed perpendicular and oblique/longitudinal to varying fracture planes (0°, 15°, 30°, 45°, and 60°). Fluoroscopic images were taken after each turn during screw insertion and analyzed. Initial screw push-off, residual fracture gap at optimal fracture gap reduction, and malreduction were determined in each trial. Statistical analysis was performed via a 1-way analysis of variance followed by Student t tests. RESULTS Malreduction was found to be significantly different between the perpendicular (1.88 mm ± 1.38) and the oblique/longitudinal (0.58 mm ± 0.23) screws. The malreduction increased for the perpendicular screw as the fracture angle increased (60° > 45°=30° > 15° > 0°). Residual fracture gap at optimal fracture gap reduction was also found to be significantly different between the perpendicular (0.97 ± 0.42) and oblique/longitudinal (1.43 ± 1.14) screws. The residual fracture gap increased for the oblique/longitudinal screw as the fracture angle increased, although the oblique/longitudinal screw with a 60° fracture angle was the only configuration significantly larger than all the other configurations. Screw push-off was not found to be significantly different between the oblique/longitudinal screw and perpendicular screw trials. CONCLUSIONS The perpendicular screw had a larger malreduction that increased with fracture angle, whereas the oblique/longitudinal screw had a larger residual fracture gap that increased with fracture angle.
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Affiliation(s)
- John P. Mickley
- The Ohio State University College of Medicine, Columbus, USA
| | - Daniel J. Lynch
- The Ohio State University College of Medicine, Columbus, USA
| | - Adam M. Gordon
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA
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Srivastav A, Behera P, Dwivedi RK, Santoshi JA. Finite Element Analysis of Postoperative Stability of Transverse Scaphoid Waist Fracture. Indian J Orthop 2024; 58:785-793. [PMID: 38812856 PMCID: PMC11130101 DOI: 10.1007/s43465-024-01156-w] [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: 12/14/2023] [Accepted: 04/12/2024] [Indexed: 05/31/2024]
Abstract
Background and Purpose Scaphoid waist fractures are often stabilised with compression screws, Kirschner wires (K-wires), or a combination of both. While clinical and bio-mechanical studies evaluating their utility are available, the ideal configuration of implant that would provide adequate stability to permit early use of the hand is debatable. We examined configurations of a single screw, one screw along with a K-wire, and two K-wires used for a transverse scaphoid waist fracture fixation aiming to assess the stability provided by each in the immediate postoperative period. Methods Computer-aided design (CAD) models of the scaphoid, K-wire, and headless compression screw were created. A transverse fracture was created at the scaphoid waist, and the CAD models of the screw and K-wire were used to fix the fracture in different configurations in a distal to proximal direction. Finite Element Analysis (FEA) was used to examine the strength of configurations when they were subjected to compression and distraction forces. The total maximum deformation (TDef) and factor of safety (FoS) for each configuration were calculated and used as indirect indicators of postoperative stability. Results When a single screw was used, the configurations with the screw directed posteriorly from either centre or anterior had the best combined TDef and FoS values. For one screw and one K-wire, the configuration with screw and K-wire parallel to each other with the screw located along the long axis in the AP projection and anterior to the K-wire in the lateral projection had the best combined TDef and FoS values. When using two K-wires, configurations with the two wires diverging proximally on the lateral projection had the best combined TDef and FoS values. Conclusions When fixing a transverse scaphoid waist fracture with a single screw, the screw directed posteriorly from either the centre or anterior aspect of the distal pole has the best stability, a parallel configuration has the best stability when fixing it using a screw and a K-wire, and divergent configuration has the best stability when fixing it with two K-wires only.
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Affiliation(s)
- Ayush Srivastav
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India
| | - Ravi Kumar Dwivedi
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, India
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Labèr R, Lautenbach G, Schweizer A. Reasons for scaphoid non-union: Analysis of behavior of health care providers and patients. HAND SURGERY & REHABILITATION 2024; 43:101662. [PMID: 38354948 DOI: 10.1016/j.hansur.2024.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
To assess factors related to health-system and patient behavior in scaphoid fracture non-union, a retrospective analysis of 134 patients treated by scaphoid reconstruction was performed. Mean age at the accident was 26 years (range, 9-75 years), and the mean age at surgery was 28 years (range, 13-75 years). Mean time to first consultation was 233 days (range, 0-12,136 days), and time to surgery 740 days (range, 19-12,362 days). The physician was mainly a general practitioner (52.2%), or an orthopedist/traumatologist (17.9%), general surgeon (12.7%), or hand surgeon (17.2%). The initial diagnostic procedure was X-ray in 76.9% of cases, computed tomography (CT) in 20.9%, magnetic resonance imaging (MRI) in 13.4%, and none in 11.2%. A fracture was diagnosed in 32.8% of cases, and non-union in 14.9%. Patients mainly presented late: 63% within 3 weeks, and a minority on the day of the accident (39%). In 11% of cases, healthcare providers performed either no or inadequate imaging (77%) and missed correct diagnosis in 52% of cases. 128 patients had a second consultation, and 77 a third, with the same or different physicians, before surgery, leading to increased healthcare costs due to delayed diagnosis and treatment. Delayed presentation and lack of suspicion by attending physicians were the main reasons. Speeding up diagnosis and improving physician training are vital and could significantly reduce health care costs. CT or MRI should be performed if scaphoid fracture is suspected.
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Affiliation(s)
- Raffael Labèr
- Department for Hand Surgery, Balgrist University Hospital, Zurich, Switzerland.
| | | | - Andreas Schweizer
- Department for Hand Surgery, Balgrist University Hospital, Zurich, Switzerland
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El Sewify O, Abi-Rafeh J, Legler J, Karimi S, Baradaran A, Efanov JI. Clinical, Radiologic, and Functional Outcomes following Bone Grafting for Metacarpal Non-Unions: A Systematic Review. J Clin Med 2024; 13:1148. [PMID: 38398461 PMCID: PMC10889921 DOI: 10.3390/jcm13041148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Objectives: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. Methods: A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. Results: Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. Conclusions: Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
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Affiliation(s)
- Omar El Sewify
- Faculty of Medicine, Laval University, Quebec, QC G1V0A6, Canada
| | - Jad Abi-Rafeh
- Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, McGill University, Montreal, QC H3G2M1, Canada
| | - Jack Legler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G2M1, Canada
| | - Shayan Karimi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G2M1, Canada
| | - Aslan Baradaran
- Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, McGill University, Montreal, QC H3G2M1, Canada
| | - Johnny I. Efanov
- Plastic and Reconstructive Surgery, Department of Surgery, Centre hospitalier de l’Universite de Montreal (CHUM), Montreal, QC H2X3E4, Canada
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Patterson ED, Elliott C, Dhaliwal G, Sayre EC, White NJ. Risk Factors for the Development of Persistent Scaphoid Non-Union After Surgery for an Established Non-Union. Hand (N Y) 2024:15589447231219523. [PMID: 38193424 DOI: 10.1177/15589447231219523] [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: 01/10/2024]
Abstract
BACKGROUND Between 2014 and 2020, candidates for scaphoid non-union (SNU) surgery were enrolled in a prospective randomized trial (Scaphoid Nonunion and Low Intensity Pulsed Ultrasound [SNAPU] trial) evaluating the effect of low-intensity pulsed ultrasound on postoperative scaphoid healing. At trial completion, 114/134 (85%) of these patients went on to union, and 20/134 (15%) went on to persistent SNU (PSNU). The purpose of this study was to use this prospectively gathered data to identify patient-, fracture-, and surgery-specific risk factors that may be predictive of PSNU in patients who undergo surgery for SNU. METHODS Data were extracted from the SNAPU trial database. The inclusion and exclusion criteria of this study were the same as that of the SNAPU trial. Nineteen patient-, fracture-, and surgery-specific risk factors were determined a priori. A stepwise multivariable logistic regression model was used to identify independent risk factors for PSNU. RESULTS Three risk factors were found to be independently significant predictors of PSNU: age at the time of surgery, dominant hand injury, and previous surgery on the affected scaphoid. With every decade of a patient's life, dominant hand injury, and previous scaphoid surgery, the odds of union are reduced by 1.72 times, 7.35 times, and 4.24 times, respectively. CONCLUSION We identified three independent risk factors for PSNU: age at SNU surgery, dominant hand injury, and previous surgery on the affected scaphoid. The findings of this study are significant and may contribute to shared decision-making and prognostication between the patient, surgeon, and affiliated members of their care team.
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Affiliation(s)
- Ethan D Patterson
- University of Calgary, AB, Canada
- Queen's University, Kingston, ON, Canada
| | | | | | - Eric C Sayre
- British Columbia Centre on Substance Use, Vancouver, Canada
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Shin SC, Kim NY, Kang HJ, Lee SW, Kim JS. Comparison of corticocancellous bone graft from the anterolateral metaphysis of the distal radius versus iliac crest for the treatment of unstable scaphoid nonunion with humpback deformity. BMC Musculoskelet Disord 2024; 25:20. [PMID: 38167040 PMCID: PMC10759349 DOI: 10.1186/s12891-023-07134-x] [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: 06/14/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Corticocancellous bone grafting from the iliac crest is acceptable treatment for unstable scaphoid nonunion with a viable proximal pole. However, harvesting graft from the iliac crest is associated with donor site morbidity and the requirement of general anesthesia. Thus, bone grafting from the anterolateral metaphysis of the distal radius (DR) can be a treatment option. However, no study has compared the clinical effect between the two grafting techniques. METHODS From 2014 to 2019, patients with unstable scaphoid nonunion with humpback deformity underwent corticocancellous bone grafting from the anterolateral metaphysis of the DR (group DR) or iliac crest (group IC). Humpback deformity was determined by evaluating the scapholunate angle (SLA) ≥ 60°, intrascaphoid angle (ISA) ≥ 45°, and radiolunate angle (RLA) ≥ 15° from preoperative radiographs and computed tomography scans. The SLA, ISA, and RLA served to gauge carpal alignment. The operative time, grip strength, active range of motion (ROM), the Modified Mayo Wrist score (MMWS), and Disabilities of Arm, Shoulder, and Hand (DASH) score were assessed postoperatively. RESULTS Thirty-eight patients qualified for the study (group DR, 15; group IC, 23). Union rates did not differ by patient subset (group DR, 100%; group IC, 95.7%; P = .827), and grip strength, ROM, MWS, and DASH score were similar between groups at the last follow-up. The operative time (minutes) was significantly shorter in group DR (median, 98; quartiles, 80, 114) than in group IC (median, 125; quartiles, 105, 150, P < .001). The ISA, RLA, and SLA improved postoperatively in both groups (P < 0.001). The degree of restoring carpal alignment, as evaluated by SLA, showed superior correction capability in group DR (median, 25.3% quartiles, 21.1, 35.3, P < 0.05). Donor site complications were not significantly different between the groups. CONCLUSIONS Corticocancellous bone graft from the anterolateral metaphysis of the DR for unstable scaphoid nonunion is associated with a shorter operation time and comparable results with that from the iliac crest in regard to union, restoration of carpal alignment, and wrist function. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sung-Chul Shin
- Department of Orthopaedic Surgery, Catholic-Kwandong University, Incheon, South Korea
| | - Nah-Yon Kim
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Shin-Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Ji-Sup Kim
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Shafer D, Ngo J, Lamb A, Vohra S. Unusual case report of concomitant lunate and scaphoid fractures without associated dislocation in a 16-year-old male. Int J Surg Case Rep 2024; 114:109146. [PMID: 38128295 PMCID: PMC10800694 DOI: 10.1016/j.ijscr.2023.109146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lunate fractures without associated dislocations are rare injuries, combination scaphoid-lunate fractures without an associated dislocation are even more rare of which few are reported in the literature. CASE PRESENTATION This case report describes a 16-year-old otherwise healthy male with ipsilateral scaphoid and lunate fractures after punching a goalpost with his left hand, for which he had surgical management. This patient had a successful treatment with two headless compression screws through a single extended carpal tunnel approach. Surgery was performed within two weeks of injury after initially immobilized with a thumb spica splint. The postoperative period was complicated by noncompliance with weight-bearing status and missed three-month followup. However, by six months, subsequent visits demonstrated radiographic and clinical healing as well as full wrist range of motion without any other sequelae. CLINICAL DISCUSSION This case offers more evidence regarding this rare injury. Lunate fractures and scaphoid fractures can both be treated with open reduction and internal fixation using headless compression screws, however little evidence exists when it comes to treating them in combination. CONCLUSION The use of headless compression screws through a single extended carpal tunnel approach led to clinical and radiographic healing in a 16 year-old-male with combined scaphoid and lunate fractures at 6 month follow up.
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Affiliation(s)
- Dylan Shafer
- Community Memorial Hospital, 147 N. Brent Street, Ventura, CA 93003, United States of America.
| | - John Ngo
- Community Memorial Hospital, 147 N. Brent Street, Ventura, CA 93003, United States of America.
| | - Ashley Lamb
- Community Memorial Hospital, 147 N. Brent Street, Ventura, CA 93003, United States of America.
| | - Sahil Vohra
- Community Memorial Hospital, 147 N. Brent Street, Ventura, CA 93003, United States of America.
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Delamarre M, Leroy M, Barbarin M, Chantelot C, Saab M. Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:507-515. [PMID: 37635175 DOI: 10.1007/s00590-023-03687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors. METHODS Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported. RESULTS This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5-20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN. CONCLUSION With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics. LEVEL OF EVIDENCE IV Retrospective cohort study.
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Affiliation(s)
- Morgane Delamarre
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Maxime Leroy
- Statistics, Economic Evaluation, Data-Management (SEED), CHU Lille, 59037, Lille Cedex, France
| | - Maxime Barbarin
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Christophe Chantelot
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France
| | - Marc Saab
- Service d'Orthopédie 1, Hôpital Roger Salengro, rue Émile Laine, 59000, Lille, France.
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10
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Khanfar A, Alswerki MN, Mousa K, Alelaumi A, Alisi MS, Al-Saber M, Hussein LA, Rabab'a H, Al Qaroot B. Scaphoid nonunion: a novel modification of Matti-Russe technique with enhanced recovery and full clinical and radiographic union. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:459-468. [PMID: 37584788 DOI: 10.1007/s00590-023-03676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND A scaphoid fracture is a common injury affecting the wrist joint. A fracture of the carpus scaphoid can heal uneventfully or be complicated by non-union. Scaphoid non-union can result in persistent wrist pain, and with functional difficulties affecting all activities of daily living of the patients, this disability is expected to be significant since most of these patients are young active adults. HYPOTHESIS Extensive removal of the bone from the scaphoid, with the application of a large amount of cancellous bone graft and fixation with two to three wires, could lead to a high union rate and a good functional outcome. METHODS Eighteen patients with scaphoid fracture non-union were recruited during their visit to the upper limb clinic at our institute. Demographic data were collected, and data regarding comorbidities, smoking, manual work, and others were recorded. Data regarding the interval between injury and surgery, time to radiographic union, and functional wrist scores were reported as well. RESULTS A cohort of 18 patients was included. The mean age of patients was 30 years; most of our patients were healthy (83.3%), and more than two-thirds were smokers (72.2%). The mean follow-up time was 18 months (1.5 years), 15 patients (83.3%) achieved radiographic unions by 2-3 months, and the remaining 3 patients (16.7%) achieved radiographic unions by (4-5) months, i.e., all patients achieved successful radiographic unions by 5 months at maximum. The mean Mayo score for our series was 83.6 (± 12.4), with 5 patients (27%) achieved ≥ 95% which indicates a significantly high functioning wrist in our cohort. CONCLUSION Our modified technique with enhanced stability from using three k-wires can achieve full clinical and radiographic unions and result in enhanced recovery postoperatively with cast immobilization limited to 6 weeks total. LEVEL OF EVIDENCE IV Case series study.
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Affiliation(s)
| | - Mohammad N Alswerki
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: 13046, Amman, 11942, Jordan.
| | | | | | - Mohammed S Alisi
- Faculty of Medicine, Islamic University of Gaza, Palestinian Ministry of Health, Palestine, Gaza, Palestine
| | | | | | | | - Bashar Al Qaroot
- Department of Prosthetics and Orthotics, Jordan University, Amman, Jordan
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11
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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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12
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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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Almeida LBCDE, Manfredi VM, Costa IAP, Imoto FS, Dobashi ET, Almeida TBCDE, Rodrigues LMR. OSTEOSYNTHESIS OF A SCAPHOID NECK FRACTURE WITH A CANNULATED COMPRESSION SCREW: EVALUATION OF 52 PATIENTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e264116. [PMID: 37876865 PMCID: PMC10592363 DOI: 10.1590/1413-785220233105e264116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/19/2022] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the dorsal fixation technique with a cannulated compression screw (CCS) for transverse scaphoid neck fractures. METHODS A case series study was carried out with patients treated with a CSS between April 2014 and May 2021. The main outcome was the healing of the fracture, verified by radiographic evaluation that used images of the wrist in anteroposterior, lateral, radial deviation, ulnar deviation and oblique views, obtained in the postoperative period. RESULTS Fifty-two patients aged between 15 and 65 years were analyzed, of which 43 (83%) were male. Of the 52 patients, 19 (36.53%) had a right-hand injury and 33 (63.46%) had a left-hand injury. Results were excellent in 47 patients (90.38%); good in 4 patients (7.69%), with reduced mobility compared to contralateral and poor in 1 patient (1.92%), with failure of consolidation and breakage of the synthesis material. In 51 cases (99%) there was bone consolidation at the end of six months. CONCLUSION Osteosynthesis with a cannulated compression screw is a safe, effective and promising method for the treatment of scaphoid neck fractures. Level of Evidence IV, Case Series.
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Affiliation(s)
| | - Victor Martins Manfredi
- Rede D'Or, Hospital IFOR, Residência Médica em Cirurgia da Mão, São Bernardo do Campo, SP, Brazil
| | - Igor Arthur Parron Costa
- Rede D'Or, Hospital IFOR, Residência Médica em Ortopedia e Traumatologia, São Bernardo do Campo, SP, Brazil
| | - Fábio Sano Imoto
- Rede D'Or, Hospital IFOR, Residência Médica em Cirurgia da Mão, São Bernardo do Campo, SP, Brazil
| | - Eiffel Tsuioshi Dobashi
- Rede D'Or, Hospital IFOR, São Bernardo do Campo, SP, Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Thiago Bernardo Carvalho DE Almeida
- Rede D'Or, Hospital IFOR, São Bernardo do Campo, SP, Brazil
- Rede D'Or, Hospital IFOR, Residência Médica em Ortopedia e Traumatologia, São Bernardo do Campo, SP, Brazil
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Orji C, Reghefaoui M, Saavedra Palacios MS, Thota P, Peresuodei TS, Gill A, Hamid P. Application of Artificial Intelligence and Machine Learning in Diagnosing Scaphoid Fractures: A Systematic Review. Cureus 2023; 15:e47732. [PMID: 38021992 PMCID: PMC10676208 DOI: 10.7759/cureus.47732] [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] [Received: 09/14/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
The integration of artificial intelligence (AI) in healthcare has sparked interest in its potential to revolutionize medical diagnostics. This systematic review explores the application of AI and machine learning (ML) techniques in diagnosing scaphoid fractures, which account for a significant percentage of carpal bone fractures and have important implications for wrist function. Scaphoid fractures, common in young and active individuals, require an early and accurate diagnosis for effective treatment. AI has the potential to automate and improve the accuracy of scaphoid fracture detection on radiography, aiding in early diagnosis and reducing unnecessary clinical examinations. This systematic review discusses the methods used to identify relevant studies, including search criteria and quality assessment tools, and presents the results of the selected studies. The findings indicate that AI-driven methods can improve diagnostic accuracy, reducing the risk of missed fractures and complications. AI assistance can also alleviate the workload of medical professionals, improving diagnostic efficiency and reducing observer fatigue. However, challenges such as algorithm limitations and the need for continuous refinement must be addressed to ensure reliable fracture identification. This review underscores the clinical significance of AI-assisted diagnostics, especially in cases where fractures may be subtle or occult. It emphasizes the importance of integrating AI into medical education and training and calls for robust data collection and collaboration between AI developers and medical practitioners. Future research should focus on larger datasets, algorithm improvement, cost-effectiveness assessment, and international partnerships to fully harness the potential of AI in diagnosing scaphoid fractures.
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Affiliation(s)
- Chijioke Orji
- Trauma and Orthopaedics, California Institute of Behavioral Neurosciences & Psychology, California, USA
| | | | | | - Priyanka Thota
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, California, USA
| | | | - Abhishek Gill
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, California, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, California, USA
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15
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Bugeja M, Calleja J, Drew T, Poghosyan G. Patient outcome scores between 1,2- and 2,3-intercompartmental supra-retinacular artery (ICSRA) pedicled vascularised bone grafts (PVBGs) in the treatment of proximal pole scaphoid fracture non-union - a questionnaire study. BMC Musculoskelet Disord 2023; 24:768. [PMID: 37770929 PMCID: PMC10537140 DOI: 10.1186/s12891-023-06870-4] [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: 02/13/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Numerous studies have been published on the use of 1,2-intercompartmental supra-retinacular artery (ICSRA) as a pedicled vascularised bone graft (PVBG) in scaphoid fracture non-union, however, only very few studies have reported their results of 2,3-ICSRA. The aim of this study was to compare the patient-rated outcome scores between these two PVBGs in proximal pole scaphoid fracture non-union. METHODS Nineteen patients who underwent surgery for scaphoid non-union between 2017 and 2021 at a single institution were recruited retrospectively in this study. All patients were operated by a one senior orthopaedic surgeon. A mailed questionnaire with the modified mayo wrist (MMW) and the patient rated wrist evaluation (PRWE) scores were sent to the patients. RESULTS All patients were males with a mean age of 22.5 years. There was no statistically significant difference in the PRWE score between the two PVBGs. However, a statistically significant difference was found in the MMW score, with the 1,2-ICSRA PVBG having better scores. CONCLUSION Despite the 2,3-ICSRA having a longer arc of rotation, longer nutrient arteries, and is technically easier to incorporate in a PVBG, when compared with the 1,2-ICSRA it did not result in better patient-rated outcome scores.
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Affiliation(s)
- Mark Bugeja
- Department of Orthopaedic and Trauma Surgery, University of Dundee, Dundee, DD1 4HN, Scotland, UK.
| | - Jordan Calleja
- Department of Orthopaedic and Trauma Surgery, Mater Dei Hospital, Msida, 2090, MSD, Malta
| | - Tim Drew
- Department of Orthopaedic and Trauma Surgery, University of Dundee, Dundee, DD1 4HN, Scotland, UK
| | - Gor Poghosyan
- Department of Orthopaedic and Trauma Surgery, Mater Dei Hospital, Msida, 2090, MSD, Malta
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16
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Kilic E, Unal KO, Ozdemir G, Bingol O, Keskin OH, Akinci M. Evaluation of free vascularized medial femoral condyle bone grafts in the treatment of avascular scaphoid waist nonunion. Jt Dis Relat Surg 2023; 34:661-668. [PMID: 37750271 PMCID: PMC10546847 DOI: 10.52312/jdrs.2023.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/20/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the medial femoral condyle (MFC) bone graft procedure for scaphoid waist nonunion with avascular necrosis on magnetic resonance imaging or prior surgery failure. PATIENTS AND METHODS Between June 2015 and December 2018, a total of 17 patients (16 males, 1 female; mean age: 29±8.2 years; range, 16 to 40 years) with scaphoid waist nonunion who were treated with vascularized MFC bone grafting were retrospectively analyzed. Pre- and postoperative carpal indices, grip strengths for both hands, range of motion, Visual Analog Scale (VAS) pain score, Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score, and Mayo Wrist Score (MWS) were evaluated. RESULTS After vascularized MFC bone graft surgery, 15 patients healed and returned to work without any limitations. Ten patients of left scaphoid nonunion and seven cases of right scaphoid nonunion were treated; for eight of these patients, the operation was on the dominant side. Eight of these patients were smokers. The mean follow-up was 22.4±5.8 months. The mean hand grip strength was increased from 74.5 to 84% on the contralateral side (p<0.05). The average revised carpal height ratio improved from 1.57 to 1.59 (p<0.05) and the scapholunate angle changed from 56.9° to 51.6° (p<0.05). CONCLUSION The MFC bone grafting is one of the best surgical procedures for small defects such as scaphoid waist nonunion with high union rates, good functional outcomes, and minimal donor site morbidity.
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Affiliation(s)
- Enver Kilic
- Ankara Bilkent Şehir Hastanesi Ortopedi ve Travmatoloji Kliniği, 06000 Çankaya, Ankara, Türkiye.
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17
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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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18
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Yoon AP, Chung WT, Wang CW, Kuo CF, Lin C, Chung KC. Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study. Clin Orthop Relat Res 2023; 481:1828-1835. [PMID: 36881548 PMCID: PMC10427075 DOI: 10.1097/corr.0000000000002612] [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: 08/20/2022] [Revised: 12/04/2022] [Accepted: 02/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Occult scaphoid fractures on initial radiographs of an injury are a diagnostic challenge to physicians. Although artificial intelligence models based on the principles of deep convolutional neural networks (CNN) offer a potential method of detection, it is unknown how such models perform in the clinical setting. QUESTIONS/PURPOSES (1) Does CNN-assisted image interpretation improve interobserver agreement for scaphoid fractures? (2) What is the sensitivity and specificity of image interpretation performed with and without CNN assistance (as stratified by type: normal scaphoid, occult fracture, and apparent fracture)? (3) Does CNN assistance improve time to diagnosis and physician confidence level? METHODS This survey-based experiment presented 15 scaphoid radiographs (five normal, five apparent fractures, and five occult fractures) with and without CNN assistance to physicians in a variety of practice settings across the United States and Taiwan. Occult fractures were identified by follow-up CT scans or MRI. Participants met the following criteria: Postgraduate Year 3 or above resident physician in plastic surgery, orthopaedic surgery, or emergency medicine; hand fellows; and attending physicians. Among the 176 invited participants, 120 completed the survey and met the inclusion criteria. Of the participants, 31% (37 of 120) were fellowship-trained hand surgeons, 43% (52 of 120) were plastic surgeons, and 69% (83 of 120) were attending physicians. Most participants (73% [88 of 120]) worked in academic centers, whereas the remainder worked in large, urban private practice hospitals. Recruitment occurred between February 2022 and March 2022. Radiographs with CNN assistance were accompanied by predictions of fracture presence and gradient-weighted class activation mapping of the predicted fracture site. Sensitivity and specificity of the CNN-assisted physician diagnoses were calculated to assess diagnostic performance. We calculated interobserver agreement with the Gwet agreement coefficient (AC1). Physician diagnostic confidence was estimated using a self-assessment Likert scale, and the time to arrive at a diagnosis for each case was measured. RESULTS Interobserver agreement among physicians for occult scaphoid radiographs was higher with CNN assistance than without (AC1 0.42 [95% CI 0.17 to 0.68] versus 0.06 [95% CI 0.00 to 0.17], respectively). No clinically relevant differences were observed in time to arrive at a diagnosis (18 ± 12 seconds versus 30 ± 27 seconds, mean difference 12 seconds [95% CI 6 to 17]; p < 0.001) or diagnostic confidence levels (7.2 ± 1.7 seconds versus 6.2 ± 1.6 seconds; mean difference 1 second [95% CI 0.5 to 1.3]; p < 0.001) for occult fractures. CONCLUSION CNN assistance improves physician diagnostic sensitivity and specificity as well as interobserver agreement for the diagnosis of occult scaphoid fractures. The differences observed in diagnostic speed and confidence is likely not clinically relevant. Despite these improvements in clinical diagnoses of scaphoid fractures with the CNN, it is unknown whether development and implementation of such models is cost effective. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - William T. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chien-Wei Wang
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chang-Fu Kuo
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chihung Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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19
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Seth I, Lim B, Xie Y, Hunter-Smith DJ, Rozen WM. Exploring the role of artificial intelligence chatbot on the management of scaphoid fractures. J Hand Surg Eur Vol 2023; 48:814-818. [PMID: 37177798 DOI: 10.1177/17531934231169858] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, 3002, Australia
| | - Yi Xie
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - David J Hunter-Smith
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - Warren M Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
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20
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Martin J, Johnson NA, Shepherd J, Dias J. Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fractures. Bone Jt Open 2023; 4:612-620. [PMID: 37599008 PMCID: PMC10440191 DOI: 10.1302/2633-1462.48.bjo-2023-0058.r1] [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: 08/22/2023] Open
Abstract
Aims There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.
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Affiliation(s)
- James Martin
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Nick A. Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jenny Shepherd
- School of Engineering, University of Leicester, Leicester, UK
| | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Leicester, UK
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21
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Toosi S, Naderi-Meshkin H, Moradi A, Daliri M, Moghimi V, Majd HM, Sahebkar AH, Heirani-Tabasi A, Behravan J. Scaphoid Bone Nonunions: Clinical and Functional Outcomes of Collagen/PGA Scaffolds and Cell-Based Therapy. ACS Biomater Sci Eng 2023; 9:1928-1939. [PMID: 36939654 DOI: 10.1021/acsbiomaterials.2c00677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
In this study, the procedure for treating the nonunion complication of scaphoid fractures using collagen/poly glycolic acid (CPGA) scaffolds with bone marrow mesenchymal stem cell (BM-MSC) therapy was adopted and compared with the commonly employed autologous bone tissue graft. With conducting a two-armed clinical trial, 10 patients with scaphoid nonunions were enrolled in this investigation. Patients were randomly assigned to two groups treated with (1) CPGA + cell therapy and (2) autologous iliac crest bone graft standard therapy. Treatment outcomes were evaluated three months after surgery, measuring the grip and pinch strengths and wrist range of motion, with two questionnaires: Patient-Rated Wrist Evaluation (PRWE) and Quick form of Disabilities of the Arm, Shoulder, and Hand (QDASH). We have also assessed the union rate using clinical and radiologic healing criteria one and three months post-operatively. Restorative effects of CPGA + cell therapy were similar to those of the autologous bone graft standard therapy, except for the grip strength (P = 0.048) and QDASH score (P = 0.044) changes, which were higher in the CPGA + cell therapy group. Three months following the surgery, radiographic images and computed tomography (CT) scans also demonstrated that the scaphoid union rate in the test group was comparable to that of scaphoids treated with the standard autograft method. Our findings demonstrate that the CPGA + cell therapy is a potential alternative for bone grafting in the treatment of bone nonunions.
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Affiliation(s)
- Shirin Toosi
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Science, Mahhad 9177899191, Iran
| | - Hojjat Naderi-Meshkin
- Stem Cells and Regenerative Medicine Research Group, Academic Center for Education Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad 91775-1376, Iran
| | - Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad 9177899191, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad 9177899191, Iran
| | - Vahid Moghimi
- Stem Cells and Regenerative Medicine Research Group, Academic Center for Education Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad 91775-1376, Iran
| | - Hasan-Mehrad Majd
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91388-13944, Iran
| | - Amir Hossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177899191, Iran
| | - Asieh Heirani-Tabasi
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center Hospital, Tehran University of Medical Sciences, Tehran 14535, Iran
| | - Javad Behravan
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177899191, Iran.,School of Pharmacy, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada
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Yong M, Liu E, Tee R, Zhang X, Tham S. Determining the optimal radiologic wrist and forearm position to visualize screw protrusion in scaphoid fixation. ANZ J Surg 2023. [PMID: 36869408 DOI: 10.1111/ans.18362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Surgical fixation of scaphoid fractures may result in unrecognized screw protrusion and subsequent cartilage damage to the adjacent joints. The purpose of this study was to use a three-dimensional (3D) scaphoid model to determine the wrist and forearm positioning that will allow intra-operative fluoroscopic visualization of screw protrusions. METHODS Two 3D scaphoid models, with the wrist in neutral and 20° ulnar deviated, were reconstructed from a cadaveric wrist using the Mimics software. The scaphoid models were divided into three segments and further divided into four quadrants in each of the three segments along the scaphoid axes. Two virtual screws, with a 2 and 1 mm groove from the distal border, were placed so that the screws protrude from each quadrant. The wrist models were rotated along the long axis of the forearm and the angles at which the screw protrusions were visualized were recorded. RESULTS One-millimetre screw protrusions were visualized at a narrower range of forearm rotation angles compared to 2 mm screw protrusions. One-millimetre screw protrusions in the middle dorsal ulnar quadrant could not be detected. Visualization of the screw protrusion in each quadrant varied with forearm and wrist positioning. CONCLUSION In this model, all screw protrusions, except 1 mm protrusions in the middle dorsal ulnar quadrant, were visualized with the forearm in pronation, supination or in the mid-pronation position and with the wrist in neutral or 20° ulnar deviated.
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Affiliation(s)
- Melodi Yong
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Edward Liu
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Richard Tee
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia
| | - Xin Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Tham
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.,Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute / St Vincents Institute, Melbourne, Victoria, Australia
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23
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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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Xiao M, Welch JM, Cohen SA, Kamal RN, Shapiro LM. How Is Scaphoid Malunion Defined: A Systematic Review. Hand (N Y) 2023; 18:38S-45S. [PMID: 34486427 PMCID: PMC10052615 DOI: 10.1177/15589447211038678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters. METHODS A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient-reported outcome measures. Study quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive summaries of the studies are presented. RESULTS The initial search yielded 1600 articles. Ten articles (161 participants, 93% males, mean age = 28.3 + 6.3 years, mean MINORS score = 10.2 + 1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45° (3 articles), LISA >35° (1 article), and height to length ratio >0.6 (3 articles). Four out of 5 studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging. CONCLUSIONS There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intrarater and interrater reliabilities for all reported imaging measurements, and utilize validated patient-reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.
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Affiliation(s)
| | | | | | | | - Lauren M. Shapiro
- Stanford University, Redwood City, CA, USA
- Duke University, Durham, NC, USA
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Chappell AG, Ramsey MD, Dabestani PJ, Ko JH. Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review. Arch Plast Surg 2023; 50:82-95. [PMID: 36755653 PMCID: PMC9902088 DOI: 10.1055/s-0042-1758639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/04/2022] [Indexed: 02/09/2023] Open
Abstract
Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.
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Affiliation(s)
- Ava G. Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Parinaz J. Dabestani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Address for correspondence Jason H. Ko, MD, MBA, Associate Professor, Program Director Plastic Surgery Residency, Division of Plastic and Reconstructive SurgeryDepartment of Orthopedic Surgery, Northwestern University Feinberg School of MedicineChicago, IL 60611
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Manako T, Imade S, Yamagami N, Yamamoto S, Uchio Y. The clinical outcomes of scaphoid nonunion treated with a precisely processed autologous bone screw: a case series. Arch Orthop Trauma Surg 2023; 143:627-635. [PMID: 34347123 DOI: 10.1007/s00402-021-04092-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Metal implants and bioabsorbable implants are frequently used in orthopaedic surgery, but they have some disadvantages. The usefulness of autologous bone has been described, and a method to precisely process autologous bone into implants such as screws and apply the implants clinically has been desired. We created a new system for manufacturing autologous bone screws during surgery and report five cases of scaphoid nonunion treated with precise autologous bone screws made from the tibial cortex using the new system. PATIENTS AND METHODS From 2012 through 2017, seven patients were diagnosed with scaphoid nonunion at our hospital and based on the inclusion/exclusion criteria, five of them were analyzed herein. The surgery was performed according to Zaidemberg's technique. The bone screw in each case was made from autologous tibial cortex using a numerically controlled lathe (model MTS4, Nano Co., Yokohama, Japan) under sterile conditions. The change in each patient's modified Mayo wrist score between the preoperative examination and at the final survey was determined, as were complications. RESULTS The median modified Mayo wrist score improved significantly from 65 to 95 points. All patients who were followed for > 2 years fused at a median duration of 3.5 months. Bone regeneration was confirmed at the donor sites in all cases. One fracture at the donor site occurred as a severe complication. CONCLUSIONS Precisely shaped autologous bone screws manufactured by a computer-assisted machine, together with a vascularized bone graft, may be a useful technique for treating scaphoid nonunions; these screws had good stability and bone replacement. Careful observation of the donor site is required. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Takuya Manako
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan.
| | - Shinji Imade
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Nobuo Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Soichiro Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan
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Resource Utilization and the Use of Bone Stimulators among Operatively and Nonoperatively Managed Scaphoid Nonunion Patients. Plast Reconstr Surg Glob Open 2023; 11:e4782. [PMID: 36776593 PMCID: PMC9911191 DOI: 10.1097/gox.0000000000004782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 02/05/2023]
Abstract
The prevalence of bone stimulator use among nonoperatively and operatively managed scaphoid nonunion patients is unknown. We hypothesize that bone stimulators are a relatively underutilized treatment for scaphoid nonunion patients. Methods We used the 2009-2017 Truven Marketscan Research Databases to identify patients with closed scaphoid fractures and performed an analysis of variance test to determine resource utilization and bone stimulator use among these patients. Results A total of 36,611 patients with scaphoid fractures were identified: 30,143 were managed nonoperatively and 6468 were managed operatively. Nonunion was diagnosed in 500 (1.66%) nonoperatively and in 1211 (19%) operatively managed patients. Bone stimulators were used in less than 2% of nonoperatively and operatively managed scaphoid nonunion patients. Conclusion Lack of trust in the technology and heterogenous (and occasionally burdensome) requirements for insurance approval are barriers to bone stimulator use; however, surgeons should examine how this technology may fit into the treatment algorithm for these difficult cases.
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Lynch D, Mickley JP, Gordon A, Roebke AJ, Goyal KS. The Effect of Derotational Kirschner Wires on Fracture Gap Reduction With Variable-Pitch Headless Screws. J Hand Surg Am 2023; 48:86.e1-86.e7. [PMID: 34802813 DOI: 10.1016/j.jhsa.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/06/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the impact of angled derotational Kirschner wires (K-wires) on fracture gap reduction with variable-pitch headless screws. METHODS Fully threaded variable-pitch headless screws (20 and 28 mm) were inserted into "normal" bone models of polyurethane blocks. In separate trials, derotational K-wires were inserted at predetermined angles of 0°, 15°, 30°, and 40° and compared with each other, with no K-wire as a control. Fluoroscopic images taken after each screw turn were analyzed. The optimal fracture gap closure, initial screw push-off, and screw back-out gap creation were determined and compared at various derotational K-wire angles. RESULTS Initial screw push-off due to screw insertion and screw back-out gap creation were not significantly affected by the angle of the derotational K-wire. With a 20-mm screw, only a 40° derotational K-wire led to significantly less gap closure compared with control and with 0°, 15°, and 30° derotational K-wires. It led to an approximately 60% decrease in gap closure compared with no K-wire. With the 28-mm screw, compared with no K-wire, 15° and 30° derotational K-wires led to statistically significant decreases in gap closure (approximately 25%), whereas a 40° derotational K-wire led to an approximately 60% decrease. With the 28-mm screw, the 40° derotational K-wire also led to a statistically significant smaller gap closure when compared with 0°, 15°, and 30° derotational K-wires. CONCLUSIONS A derotational K-wire placed in parallel to the planned trajectory of a headless compression screw does not affect fracture gap closure. With greater angulation of the derotational K-wire, the fracture gap is still closed, but less tightly. CLINICAL RELEVANCE Derotational K-wires can help prevent fracture fragment rotation during headless compression screw insertion. At small deviations from parallel (≤30°), fracture gap closure achieved by the screw is minimally affected. At greater angles (ie, 40°), fracture gap closure may be substantially reduced, preventing fracture compression.
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Affiliation(s)
- Daniel Lynch
- Ohio State University College of Medicine, Columbus, OH
| | | | - Adam Gordon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Dean BJF, Berridge A, Berkowitz Y, Little C, Sheehan W, Riley N, Costa M, Sellon E. The reliability and clinical utility of a simple MRI based classification tool for acute scaphoid injuries: the OxSMART. Bone Jt Open 2022; 3:913-920. [DOI: 10.1302/2633-1462.311.bjo-2022-0129.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims The evidence demonstrating the superiority of early MRI has led to increased use of MRI in clinical pathways for acute wrist trauma. The aim of this study was to describe the radiological characteristics and the inter-observer reliability of a new MRI based classification system for scaphoid injuries in a consecutive series of patients. Methods We identified 80 consecutive patients with acute scaphoid injuries at one centre who had presented within four weeks of injury. The radiographs and MRI scans were assessed by four observers, two radiologists, and two hand surgeons, using both pre-existing classifications and a new MRI based classification tool, the Oxford Scaphoid MRI Assessment Rating Tool (OxSMART). The OxSMART was used to categorize scaphoid injuries into three grades: contusion (grade 1); unicortical fracture (grade 2); and complete bicortical fracture (grade 3). Results In total there were 13 grade 1 injuries, 11 grade 2 injuries, and 56 grade 3 injuries in the 80 consecutive patients. The inter-observer reliability of the OxSMART was substantial (Kappa = 0.711). The inter-observer reliability of detecting an obvious fracture was moderate for radiographs (Kappa = 0.436) and MRI (Kappa = 0.543). Only 52% (29 of 56) of the grade 3 injuries were detected on plain radiographs. There were two complications of delayed union, both of which occurred in patients with grade 3 injuries, who were promptly treated with cast immobilization. There were no complications in the patients with grade 1 and 2 injuries and the majority of these patients were treated with early mobilization as pain allowed. Conclusion This MRI based classification tool, the OxSMART, is reliable and clinically useful in managing patients with acute scaphoid injuries. Cite this article: Bone Jt Open 2022;3(11):913–920.
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Affiliation(s)
- Benjamin J. F. Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Anna Berridge
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | | | - Warren Sheehan
- Emergency Department, John Radcliffe Hospital, Oxford, UK
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Özdemir MA, Bayram S, Ayik Ö, Pehlivanoglu T, Salduz A, Akgül T, Durmaz H. Comparison of clinical outcomes of autologous bone graft versus pronator quadratus pedicled vascularized bone graft in the treatment of scaphoid nonunion. Acta Orthop Belg 2022; 88:447-455. [PMID: 36791697 DOI: 10.52628/88.3.0001] [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: 02/16/2023]
Abstract
We aimed to compare the union rate and clinical outcome of autologous bone graft versus pronator quadratus vascularized pedicled muscle flap in treatment of scaphoid nonunion. Forty patients with a diagnosis of scaphoid nonunion who underwent unilateral pseudarthrosis surgery were included in this study. Notably, the scaphoid nonunion was unilateral, and the contralateral wrist was asymptomatic with normal function, per the physical and radiological examinations. Pronator quadratus vascularized pedicled muscle flap was used in 16 patients (group 1), and autologous bone graft was used in 24 patients (group 2). Patients were compared used Scapholunate angles, Natrass carpal height ratio and Mayo wrist score pre and postoperatively. Fifteen of the 16 (93.3%) patients in group 1 and 19 of the 24 (79.2%) patients in group 2 achieved bone union. Four of twelve patients in group 2 with avascular necrosis (AVN) and one of eight in group 1 with AVN were not able to achieve union. The group 2 (34%) had higher nonunion rate than group 1 (12%) in AVN patients. The scapholunat angle was significantly decreased and the Natress ratio was significantly increased postoperatively compared to the preoperative measurement in both group. There was no statistically significant difference in the postoperative measurement. The postoperative Mayo wrist score showed no statistically significant differences between both groups. The pronator quadratus vascularized pedicled muscle flap was superior to non-vascularized bone grafting in the treatment of scaphoid nonunion with AVN. However, management of the patients without avascular necrosis is not requiring the vascularized pedicled muscle flap technique.
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Yin Y, Xu K, Zhang N, Yi Z, Liu B, Chen S. Clinical and Epidemiological Features of Scaphoid Fracture Nonunion: A Hospital-Based Study in Beijing, China. Orthop Surg 2022; 14:2455-2461. [PMID: 36000517 PMCID: PMC9531078 DOI: 10.1111/os.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/30/2022] [Accepted: 07/30/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Studies exploring the epidemiological characteristics of scaphoid fracture nonunion are important to understand the causes and lead to effective prevention strategy. However, such knowledge is limited especially in China. This study aims to reveal the clinical and epidemiological features of scaphoid fracture nonunion in Chinese patients. Methods This was a retrospective study, which was based on patients with scaphoid fracture nonunion treated in a Chinese national orthopedic referral center from 1 August 2009 to 1 August 2020. The basic demographic and clinical characteristics, including gender, age at diagnosis of scaphoid fracture nonunion, dominant hand, the location of fracture, the side, the causes of the injury, age of the injury, age of the treatment for scaphoid fracture nonunion, and the delay period, were retrieved from the medical records. The patients were divided into a non‐delay group and a delay group based on whether they had visited the doctor within 1 month after the injury. Scaphoid fracture was classified into the proximal, waist, and distal fractures according to the location. The t‐test or Mann–Whitney U test was used to compare the difference between groups when the dependent variable is continuous, while a chi‐square test was used when the dependent variable is categorical. Results A total of 363 patients were included in this study. The mean age at the diagnosis of scaphoid fracture nonunion was 32 (ranging from 14 to 78). Waist fracture nonunion (76.5%) was most common. Among the 169 patients who sought medical care within 1 month after the injury (non‐delay group), more than half (90 cases) were misdiagnosed. 23 cases could not recall the injury, so the time of delay could not be determined. Among the 171 patients who did not seek medical care for acute injury (delay group), the average time was 52 months between the initial injury and the treatment. The proportion of waist nonunions was higher among patients in the delay group than that in the non‐delay group. Conclusions Nonunion of scaphoid fracture is caused mainly by delayed treatment and misdiagnosis in China, suggesting that timely treatment and improved diagnosis could lower the prevalence. The fracture location may be a factor contributing to the delaying of seeking medical care.
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Affiliation(s)
- Yaobin Yin
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Ke Xu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Nan Zhang
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Zhe Yi
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
| | - Shanlin Chen
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Wu F, Zhang Y, Liu B. Arthroscopic bone graft and fixation for proximal scaphoid nonunions. Bone Joint J 2022; 104-B:946-952. [PMID: 35909374 DOI: 10.1302/0301-620x.104b8.bjj-2022-0198.r1] [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: 11/05/2022]
Abstract
AIMS This study aims to report the outcomes in the treatment of unstable proximal third scaphoid nonunions with arthroscopic curettage, non-vascularized bone grafting, and percutaneous fixation. METHODS This was a retrospective analysis of 20 patients. All cases were delayed presentations (n = 15) or failed nonoperatively managed scaphoid fractures (n = 5). Surgery was performed at a mean duration of 27 months (7 to 120) following injury with arthroscopic debridement and arthroscopic iliac crest autograft. Fracture fixation was performed percutaneously with Kirschner (K)-wires in 12 wrists, a headless screw in six, and a combination of a headless screw and single K-wire in two. Clinical outcomes were assessed using grip strength, patient-reported outcome measures, and wrist range of motion (ROM) measurements. RESULTS Intraoperatively, established avascular necrosis of the proximal fragment was identified in ten scaphoids. All fractures united within 16 weeks, confirmed by CT. At a mean follow-up of 31 months (12 to 64), there were significant improvements in the Patient-Rated Wrist Evaluation, Mayo Wrist Score, abbreviated Disabilities of the Arm, Shoulder and Hand score, wrist ROM, grip strength, and the patients' subjective pain score. No peri- or postoperative complications were encountered. CONCLUSION Our data indicate that arthroscopic bone grafting and fixation with cancellous autograft is a viable method in the treatment of proximal third scaphoid nonunions, regardless of the vascularity of the proximal fragment. Cite this article: Bone Joint J 2022;104-B(8):946-952.
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Affiliation(s)
- Feiran Wu
- Birmingham Hand Centre, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Yuhao Zhang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Jishuitan Hospital, the fourth Clinical College of Peking University, Beijing, China
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Çolak İ, Akgün E, Kılıç Z, Özel M. Vascularized Bone Grafting in the Treatment of Scaphoid Nonunion: A Clinical and Functional Outcome Study. J Wrist Surg 2022; 11:288-294. [PMID: 35971465 PMCID: PMC9375677 DOI: 10.1055/s-0041-1733941] [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: 02/27/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
Background A malreduction or missed scaphoid fracture may lead to nonunion or avascular necrosis (AVN). The aim of this study was to analyze the radiological and clinical outcome of patients with scaphoid nonunion (SN), who were treated with 1,2-intercompartmental supraretinacular artery pedicled vascularized bone graft (1,2-ICSRA-VBG) fixed with K-wires or screws between 2014 and 2018. Methods Radiological assessment included posteroanterior, lateral, oblique, and angled posteroanterior projection. The wrist active joint range of motion was assessed with a universal goniometer, and grip and pinch strength with a dynamometer. The disabilities of the arm, shoulder and hand (DASH) questionnaire was used to evaluate functionality. Statistical analysis was performed using SPSS software (v16.0). Results A total of 68 patients (65 male) with a mean age 29.7 ± 8.5 years were evaluated in the study, and union was achieved in 55 (81%). A total of 45 (66%) patients had scaphoid waist fracture and 48 (71%) had AVN. Fixation was achieved with K-wires in 48 of the patients, and with screw in 20. The mean length of follow-up was 31.6 ± 14.6 (12-72) months. The mean radioulnar range of motion and DASH scores improved significantly after treatment ( p < 0.001, p ≤ 0.001). Conclusions The findings of this study showed that scaphoid unions can be treated successfully with high rates of union using the 1,2-ICSRA-VBG. This surgical technique requires special surgical experience. The functional outcome of patients improved after treatment, although smoking was found to be an important factor affecting functional results.
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Affiliation(s)
- İlker Çolak
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kırdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Emrecan Akgün
- Department of Orthopaedics and Traumatology, Marmara University, Pendik Education and Research Hospital, Istanbul, Turkey
| | - Zülfü Kılıç
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kırdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Murat Özel
- Department of Orthopaedics and Traumatology, Dr. Lütfi Kırdar Kartal Education and Research Hospital, Istanbul, Turkey
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DE VITIS R, PASSIATORE M, PERNA A, CILLI V, PONZO I, TACCARDO G. Does the Use of Gelled Platelet-Rich Plasma during Fixation of Subacute Proximal Pole Scaphoid Fractures Help? – A Single Centre Experience. J Hand Surg Asian Pac Vol 2022; 27:615-622. [DOI: 10.1142/s2424835522500588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Subacute proximal pole scaphoid fractures (1 month to 6 months) have a higher risk of non-union. The aim of the present retrospective analysis is to evaluate the efficacy of gelled platelet-rich plasma (GPRP) as additional treatment to antegrade headless screw fixation of proximal pole scaphoid fractures. Methods: Forty-one patients were divided into two groups based on surgical treatment received: screw fixation alone (group A) and screw fixation and GPRP application at the fracture site (group B). A short cast was maintained for 4 weeks after surgery. Outcome measures included time to union, need for additional procedures, time to return to work, disabilities of the arm, shoulder, and hand (DASH) questionnaire, Michigan Hand Questionnaire (MHQ) and Mayo wrist score (MWS).Time to union was determined by monthly radiographs and confirmed by a computerized tomographic (CT) scan done at 4 months. Results: Union was achieved in 85.7% of patients in group A and in 100% of patients in group B. Patients in group B showed a faster time to healing (2.3 ± 0.4 months vs 3.1 ± 0.7 months, p = 0.0001) and earlier return to work (10.4 ± 2.2 vs 15.1 ± 2.9, p = 0.0001). There were no significant differences in patient-rated outcomes scores between the two groups at final follow-up. Conclusions: Internal fixation alone is effective in treating subacute proximal pole scaphoid fractures. GPRP application improves bone healing and functional recovery. Level of Evidence: Level III (Therapeutic)
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Affiliation(s)
- Rocco DE VITIS
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco PASSIATORE
- Unit of Orthopedics and Traumatology 2, Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Andrea PERNA
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vitale CILLI
- Hand Surgery Unit, CHIREC Site Delta, Bruxelles, Belgium
| | - Ida PONZO
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe TACCARDO
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Abstract
In recent decades, there has been a trend toward increased use of operative treatment of hand fractures. However, internal stabilization with wires or open reduction and internal fixation of the phalanges and the metacarpals carries a risk of surgical complications that can be avoided by using appropriate conservative treatment. In this article, some hand fractures that can be managed safely without surgery are discussed. In conclusion, when facing a fracture in the hand, the first consideration is whether the fracture can be treated nonoperatively and not which operative treatment is most appropriate. This applies to both displaced and undisplaced fractures.
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Moeller JL. Pelvic Avulsion Fractures in Adolescent Athletes: Analyzing the Effect of Delay in Diagnosis. Clin J Sport Med 2022; 32:368-374. [PMID: 35762861 DOI: 10.1097/jsm.0000000000000977] [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: 02/16/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. DESIGN Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. SETTING Private practice, primary care sports medicine clinic. PATIENTS Patients younger than 20 years diagnosed with pelvic region avulsion fracture. INTERVENTIONS None, this was a retrospective study. MAIN OUTCOME MEASURES Clearance for return toward sport activities. RESULTS Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. CONCLUSIONS Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.
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Affiliation(s)
- James L Moeller
- Sports Medicine Division, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan
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Testa G, Lucenti L, D’Amato S, Sorrentino M, Cosentino P, Vescio A, Pavone V. Comparison between Vascular and Non-Vascular Bone Grafting in Scaphoid Nonunion: A Systematic Review. J Clin Med 2022; 11:jcm11123402. [PMID: 35743472 PMCID: PMC9225170 DOI: 10.3390/jcm11123402] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts. Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included. Results: A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above. Conclusions: The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon’s knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases.
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Leti Acciaro A, Lana D, Fagetti A, Cherubino M, Adani R. Plate fixation in challenging traumatic carpal scaphoid lesions. Musculoskelet Surg 2022; 106:179-185. [PMID: 33393002 DOI: 10.1007/s12306-020-00689-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Complex fractures of the carpal scaphoid with poles fragmentation, edges comminution, bone loss and non-union of fractures previously treated by screw fixation remain challenging for hand surgeons. The authors present the indications, advantages and results of scaphoid plating, underlining the importance of correct plate positioning well shaped onto the bone. MATERIALS AND METHODS The study includes 11 patients presenting acute fracture with distal pole fragmentation, acute fracture with comminution and non-union after prior failure of screw fixation. All patients were treated with volar locked plate fixation, adding a cortical bone graft in cases of non-union. RESULTS Bone consolidation was achieved in all cases; excellent outcomes in fracture healing and relevant improvement in symptoms and functions were obtained in non-union group that are consistent with the literature. Only one patient underwent early further surgery (first row carpectomy) with poor results. CONCLUSION The treatment of the selected scaphoid lesions with volar locked plate is a surely efficient technique. The plate can be easily adjusted to the shape of the scaphoid and can achieve an adequate correction of bone deformity and high degree of stability both in non-union and fractures.
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Affiliation(s)
- A Leti Acciaro
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
| | - D Lana
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy.
| | - A Fagetti
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - M Cherubino
- SSD of Hand Surgery and Microsurgery, ASST Settelaghi, Varese, Italy
| | - R Adani
- C.S. of Hand Surgery and Microsurgery, AOU Policlinico of Modena, Largo del Pozzo 71, 41125, Modena, Italy
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Konstantinidis I, Christidis P, Konstantinou P, Kostretzis L, Pinto I, Papadopoulos P, Ditsios T, Palechoros G, Ditsios K. The Influence of Smoking on Healing of Scaphoid Non-union after a Vascularized Pedicle Bone Flap Operation: A Review and Meta-analysis. Orthop Rev (Pavia) 2022; 14:35446. [PMID: 35936802 PMCID: PMC9347666 DOI: 10.52965/001c.35446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing. MATERIALS AND METHODS Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG. RESULTS Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001). CONCLUSIONS A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.
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Affiliation(s)
| | | | - Panagiotis Konstantinou
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Lazaros Kostretzis
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Iosafat Pinto
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Polichronis Papadopoulos
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | - Georgios Palechoros
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Konstantinos Ditsios
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
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Konstantinidis I, Christidis P, Konstantinou P, Kostretzis L, Pinto I, Papadopoulos P, Ditsios T, Palechoros G, Ditsios K. The Influence of Smoking on Healing of Scaphoid Non-union after a Vascularized Pedicle Bone Flap Operation: A Review and Meta-analysis. Orthop Rev (Pavia) 2022; 14:35446. [PMID: 35936802 PMCID: PMC9347666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/05/2022] [Indexed: 03/18/2023] Open
Abstract
Background The purpose of this study is to compare the vascularized bone flaps (VBF) that are used in operations for scaphoid non-union in smokers and non-smokers and to scrutinize if the better biological potential of the VBFs can counteract the negative influence of smoking on healing. Materials and Methods Our study included articles published until 2016, with scaphoid non-union patients who were operated on with a VBF or a VBG. Results Eighteen articles met eligibility criteria with 335 non-smokers and 136 smokers totally. Healing of the scaphoid non-union was significantly more probable in the non-smoking group (OR=5.54, p<0.001). Patients with avascular necrosis in the proximal pole of the scaphoid (AVNPP) and non-AVNPP showed that non-smoking favors a better healing rate in both of these subgroups (p<0.001 and p<0.001, respectively). Non-smokers have 11 times and the non-AVNPP patient's 7.7 times greater probability of healing of the non-union. Meta-analysis of the data for time for healing showed a longer time in the smokers' group by 2.46 weeks, though non-statistically significant. The analysis could not prove that smoking is a predisposing factor for the development of AVNPP (spearman=0.094, p<0.05). Despite that, preoperative smoking cessation proved to be an inadequate healing moderator (OR=3.5, p=0.268). Finally, VBFs showed a significantly better healing rate compared with nVBGs in smokers (p=0.001). Conclusions A hand surgeon should always take into consideration that smoking negatively influences the healing potential of a scaphoid non-union despite the theoretically superior biological background that VBFs offer. In patients who refuse to quit smoking, a VBF may be considered a better choice than a conventional graft.
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Affiliation(s)
| | | | - Panagiotis Konstantinou
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Lazaros Kostretzis
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Iosafat Pinto
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Polichronis Papadopoulos
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | | | - Georgios Palechoros
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
| | - Konstantinos Ditsios
- 2nd Academic Department of Orthopedic Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "G. Gennimatas", Greece
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Duncumb JW, Robinson PG, Williamson TR, Murray IR, Campbell D, Molyneux SG, Duckworth AD. Bone grafting for scaphoid nonunion surgery : a systematic review and meta-analysis. Bone Joint J 2022; 104-B:549-558. [PMID: 35491585 DOI: 10.1302/0301-620x.104b5.bjj-2021-1114.r1] [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: 11/05/2022]
Abstract
AIMS The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN). METHODS A search of PubMed, MEDLINE, and Embase was performed in June 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and registered using the PROSPERO International prospective register of systematic reviews. The primary outcome was union rate. RESULTS There were 78 studies that met the inclusion criteria with a total of 7,671 patients (87.8% male, 12.2% female). The mean age was 27.9 years (SD 3.8) and the mean follow-up was 30.9 months (SD 25.9). The mean union rate was 88.7% (95% confidence interval (CI) 85.0 to 92.5) for non-vascularized grafts versus 87.5% (95% CI 82.8 to 92.2) for vascularized grafts (p = 0.685). Pooled analysis of trial data alone found a mean union rate of 82.4% (95% CI 66.9% to 97.9%) for non-vascularized grafts and 89.4% (95% CI 84.1% to 94.7%) for vascularized grafts (p = 0.780). No significant difference was observed in union rates between any of the fixation techniques used in the studies (p = 0.502). Distal radius and iliac crest graft source had comparable mean union rates (86.9% (95% CI 83.1 to 90.7) vs 87.6% (95% CI 82.2 to 92.9); p = 0.841). Studies that excluded patients with both proximal pole fractures and AVN (n = 14) had a mean union rate of 96.5% (95% CI 94.2 to 98.9) that was significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies (p < 0.001). CONCLUSION Current evidence suggests vascularized bone grafting does not yield significantly superior results to non-vascularized grafting in scaphoid nonunion management. However, potential selection bias lessens the certainty of these findings. The fixation type or source of the graft used was not found to influence union rates either. Sufficiently designed and powered prospective randomized controlled trials in this area are needed. Cite this article: Bone Joint J 2022;104-B(5):549-558.
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Affiliation(s)
- Joseph W Duncumb
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Tom R Williamson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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Hein RE, Fletcher AN, Tillis RT, Pang EQ, Ruch DS, Richard MJ. Association of Lunate Morphology With Progression to Scaphoid Fracture Nonunion. Hand (N Y) 2022; 17:452-458. [PMID: 32697111 PMCID: PMC9112753 DOI: 10.1177/1558944720937368] [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: 11/15/2022]
Abstract
Background: The purpose of our study was to review a series of patients with scaphoid fractures to determine whether there was an association between lunate morphology and progression to delayed union or nonunion when treated operatively or nonoperatively. Secondary aims included evaluation of the relationship between lunate morphology and scaphoid fracture location. Methods: A retrospective review of all patients with a diagnosis of scaphoid fracture was performed at our institution between 2014 and 2017. Medical records and radiographs were evaluated to determine lunate morphology, scaphoid fracture location, treatment, and time to union. Differences between groups were determined using χ2 analysis with significance set at P <.05. Multiple logistic regression analyses were used to evaluate scaphoid union in the setting of lunate morphology when controlling for confounders. Results: A total of 169 patients were included; 45.0% (n = 76) of patients had type I lunate morphology, and 55.0% (n = 93) had type II. In all, 64.5% (n = 49) of patients with type I lunate and 68.8% (n = 64) with type II lunate had a fracture at the scaphoid waist. Among all patients with a scaphoid fracture, type II lunates were more likely than type I lunates to progress to nonunion when treated both operatively and nonoperatively (18.3% vs 4.0%, P = .0042). Lunate facet size was not shown to be a significant risk factor for nonunion among patients with a type II lunate (P = .4221). Conclusions: Patients with a scaphoid fracture and type II lunate morphology were more likely to progress to nonunion than patients with a type I lunate.
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Affiliation(s)
- Rachel E. Hein
- Duke University Medical Center, Durham, NC, USA,Rachel E. Hein, 2301 Erwin Road, Durham, NC 27710, USA.
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Abstract
BACKGROUND The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF). METHODS A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications. RESULTS Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity. CONCLUSIONS Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents. LEVEL OF EVIDENCE Level IV, therapeutic.
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Reeh FM, Sachse S, Wedekind L, Hofmann GO, Lenz M. Nonunions and Their Operative Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:869-875. [PMID: 36352531 PMCID: PMC9989962 DOI: 10.3238/arztebl.m2022.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/25/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonunions, which arise as a complication of fractures, are an impor - tant medical and socio-economic problem. The goal of this study was to analyze nonunions in Germany with respect to the patients' age and sex, the anatomical site of the lesions, and their operative treatment. METHODS The study was performed on the basis of DRG (diagnosis-related group) data acquired for billing purposes and collected by the German Federal Statistical Office. The administrative frequencies of nonunions and fractures treated in the inpatient setting, broken down by sex and age group, were calculated from the documentation of ICD codes. An investigation was also made of surgical treatments for nonunion, as they were categorized by the German procedure classification (Operationen- und Prozedurenschlüssel, OPS). RESULTS The administrative frequency of nonunion was 14.84 per 100 000 persons per year, with a 2% decline in case numbers over the period 2007-2019. Nonunions develop in 2% of fractures. Nonunions affect men more often than women (58% vs. 42%). In men, their incidence as a function of age is highest under age 30; in women, it rises steadily with increasing age. The most common type of surgical treatment is a combination of resection, bone transplantation, and osteosynthesis. CONCLUSION This is the first detailed nationwide study of diagnoses of nonunions in Germany and their surgical treatment. Despite a slow decline in their incidence, nonunions remain an important problem in the inpatient setting. The risk profile for nonunions is sex-, age-, and site-specific.
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Affiliation(s)
- Freya M Reeh
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, FriedrichSchiller University of Jena; Institute for Medical Statistics, Computer and Data Sciences, University Hospital of Jena, Friedrich-Schiller-University of Jena
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Smolle MA, Leitner L, Böhler N, Seibert FJ, Glehr M, Leithner A. Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1006-1019. [PMID: 34909221 PMCID: PMC8631245 DOI: 10.1302/2058-5241.6.210058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients. A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins’ I2, publication bias with Harbord’s p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale. Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%). Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections.
Cite this article: EFORT Open Rev 2021;6:1006-1019. DOI: 10.1302/2058-5241.6.210058
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Nikolaus Böhler
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria
| | - Franz-Josef Seibert
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Mathias Glehr
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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Stirling PHC, Strelzow JA, Doornberg JN, White TO, McQueen MM, Duckworth AD. Diagnosis of Suspected Scaphoid Fractures. JBJS Rev 2021; 9:01874474-202112000-00001. [PMID: 34879033 DOI: 10.2106/jbjs.rvw.20.00247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Suspected scaphoid fractures are a diagnostic and therapeutic challenge despite the advances in knowledge regarding these injuries and imaging techniques. The risks and restrictions of routine immobilization as well as the restriction of activities in a young and active population must be weighed against the risks of nonunion that are associated with a missed fracture. » The prevalence of true fractures among suspected fractures is low. This greatly reduces the statistical probability that a positive diagnostic test will correspond with a true fracture, reducing the positive predictive value of an investigation. » There is no consensus reference standard for a true fracture; therefore, alternative statistical methods for calculating sensitivity, specificity, and positive and negative predictive values are required. » Clinical prediction rules that incorporate a set of demographic and clinical factors may allow stratification of secondary imaging, which, in turn, could increase the pretest probability of a scaphoid fracture and improve the diagnostic performance of the sophisticated radiographic investigations that are available. » Machine-learning-derived probability calculators may augment risk stratification and can improve through retraining, although these theoretical benefits need further prospective evaluation. » Convolutional neural networks (CNNs) are a form of artificial intelligence that have demonstrated great promise in the recognition of scaphoid fractures on radiographs. However, in the more challenging diagnostic scenario of a suspected or so-called "clinical" scaphoid fracture, CNNs have not yet proven superior to a diagnosis that has been made by an experienced surgeon.
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Affiliation(s)
- Paul H C Stirling
- Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jason A Strelzow
- Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Job N Doornberg
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Groningen, UMCG, Groningen, the Netherlands
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Timothy O White
- Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Margaret M McQueen
- Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics and University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Bezirgan U, Acar E, Özbek EA. Can headless screw used in fixation of the scaphoid proximal pole fracture be broken after wrist trauma? An unreported complication of scaphoid surgery. Jt Dis Relat Surg 2021; 32:779-785. [PMID: 34842114 PMCID: PMC8650677 DOI: 10.52312/jdrs.2021.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 11/14/2022] Open
Abstract
The post-traumatic impairment of blood supply of the scaphoid bones' proximal pole is the subject of controversy in the surgical techniques which would heal this fracture. In a surgery performed with a dorsal approach, the main goal is to make a strong fixation with a small incision and a good implant without disturbing the blood supply of the bone. To date, complications related to surgical treatment of scaphoid proximal pole fractures have been reported in detail. However, there is no other study which presents headless screw failure which placed for the scaphoid proximal pole fracture surgery. Although implant technologies have been developed nowadays, our case report highlights that the endurance of these implants has not been carried out in such proximal pole fractures of the scaphoid, yet. Herein, we present the explanation of a broken headless screw which was placed into the proximal pole fracture of scaphoid, avoiding to affect bone stock of the scaphoid surgical technique. We believe that this surgical technique would be helpful to manage similar difficult situations for orthopedic surgeons.
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Affiliation(s)
| | | | - Emre Anıl Özbek
- Ankara Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 06590 Çankaya, Ankara, Türkiye.
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Cohen A, Hoogendam L, Reijman M, Selles RW, Hovius SER, Colaris JW. Patient-reported physical functioning and pain improve after scaphoid nonunion surgery: A Cohort Study. Injury 2021; 52:2952-2958. [PMID: 34253353 DOI: 10.1016/j.injury.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Since all patients with a scaphoid nonunion are generally treated surgically to prevent progressive osteoarthritis, it is important to set postoperative expectations regarding physical functioning and pain. Previous study mainly focus on postoperative scaphoid union and physician-based outcomes. Therefore we aim to report the change from preoperative to postoperative patient-reported outcomes to inform patients with a scaphoid nonunion about their postoperative expectations. MATERIAL AND METHODS Data were prospectively collected as part of usual care at the Xpert Clinic in the Netherlands. Adult patients who underwent scaphoid nonunion surgery minimally 3 months after a scaphoid fracture, were eligible for inclusion. Only patients with complete preoperative and postoperative questionnaires regarding our primary outcome (Patient Rated Hand/Wrist Evaluation (PRWHE) were included. As secondary outcomes, we assessed the Visual Analog Scale (VAS) pain and hand function, range of motion of the injured wrist measured by a hand therapist, and patient satisfaction with questionnaires. RESULTS We included 118 patients with complete preoperative and postoperative (11 - 92 months) PRWHE questionnaires. The median PRWHE score improved significantly from 47 [IQR 27 - 62]) preoperative to 11 [IQR 5 - 23] postoperative (p<0.001). Postoperative improvement in pain and physical functioning was also observed in the PWRHE subdomains pain and disability separately (p<0.001), VAS pain, and VAS function (p<0.001). There was no difference between preoperative and postoperative range of motion of the injured wrist. Satisfaction with the hand improved significantly from preoperative to postoperative (p<0.001). Good or excellent satisfaction with the treatment result was reported by 69% of the patients and 86% would undergo the treatment again. CONCLUSIONS Patients can expect an improvement in physical functioning and pain after scaphoid nonunion surgery. Most patients are satisfied with the treatment result.
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Affiliation(s)
- Abigael Cohen
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Steven E R Hovius
- Hand and Wrist Center, Xpert Clinic, 1213 RH Hilversum, the Netherlands
| | - Joost W Colaris
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
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Feeley A, Feeley I, Ni Fhoghlú C, Sheehan E, Kennedy M. Use of biomaterials in scaphoid fracture fixation, a systematic review. Clin Biomech (Bristol, Avon) 2021; 89:105480. [PMID: 34530377 DOI: 10.1016/j.clinbiomech.2021.105480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scaphoid fractures account for 60-70% carpal injury. Due to limited vascular supply achieving adequate reduction and healing is important to avoid complications including avascular necrosis. Recent technological advances have led to renewed vigour in bioabsorbable material research to develop devices which could be used without the need for removal and complications including stress shielding and suboptimal imaging. METHODS A systematic search of databases including PubMed, Ovid Medline, and Google Scholar databases was made to identify studies related to the use of bioabsorbable materials in scaphoid fixation and postoperative patient outcomes. PRISMA guidelines were utilised for this review. FINDINGS Initial search results yielded 852 studies. 124 studies were screened, with 79 patients across 7 studies included in this review. Poly-L-Lactic acid derivatives were the most common biomaterial for scaphoid fixation, with magnesium and polyglycolide also used. Levels of evidence for studies ranged between III-IV. Analysis demonstrated mixed findings with generally comparable outcomes to conventional alloy-based screws. INTERPRETATION Development in bioabsorbable materials is ongoing, however there remains a dearth in data regarding their use in the scaphoid. Further research is needed to establish the efficacy and applicability of bioabsorbable devices in the scaphoid bone.
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Affiliation(s)
- Aoife Feeley
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Ireland; School of Medicine, University College Dublin, Ireland.
| | - Iain Feeley
- Department of Orthopaedics, National Orthopaedic Hospital Cappagh, Ireland
| | | | - Eoin Sheehan
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Ireland
| | - Muiris Kennedy
- Department of Orthopaedics, Midlands Regional Hospital Tullamore, Ireland
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Jerome JTJ. Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases. J Wrist Surg 2021; 10:368-376. [PMID: 34631288 PMCID: PMC8489989 DOI: 10.1055/s-0040-1721435] [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: 08/28/2020] [Accepted: 10/28/2020] [Indexed: 10/22/2022]
Abstract
Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35-82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10-62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical Relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of Evidence This is a Level IV study.
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Affiliation(s)
- J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India
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