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Quadlbauer S, Pezzei C, Jurkowitsch J, Beer T, Moser V, Rosenauer R, Salminger S, Hausner T, Leixnering M. Double screw versus angular stable plate fixation of scaphoid waist nonunions in combination with intraoperative extracorporeal shockwave therapy (ESWT). Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04806-0. [PMID: 36808564 DOI: 10.1007/s00402-023-04806-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/29/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Over the past years, different fixation techniques focused on rotational stability in order to increase stability and stimulate union rates. Additionally, extracorporeal shockwave therapy (ESWT) has gained importance in the treatment of delayed and nonunions. Purpose of this study was to compare the radiological and clinical outcome of two headless compression screws (HCS) and plate fixation in scaphoid nonunions, in combination with intraoperative high energy ESWT. MATERIALS AND METHODS Thirty-eight patients with scaphoid nonunions were treated by using a nonvascularized bone graft from the iliac crest and stabilization with either two HCS or a volar angular stable scaphoid plate. All patients received one ESWT session with 3000 impulses and energy flux per pulse of 0.41 mJ/mm2 intraoperatively. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O'Brien (Mayo) Wrist Score. To confirm union, a CT scan of the wrist was performed. RESULTS Thirty-two patients returned for clinical and radiological examination. Out of these, 29 (91%) showed bony union. All patients treated with two HCS compared to 16 out of 19 (84%) patients treated by plate showed bony union on the CT scans. The difference was not statistically significant. However, at a mean follow-up interval of 34 months, no significant differences could be found in ROM, pain, grip strength and patient-reported outcome measurements between the two HCS and plate group. Height-to-length ratio and capitolunate angle improved significantly in both groups compared to preoperative. CONCLUSIONS Scaphoid nonunion stabilization by using two HCS or angular stable volar plate fixation and intraoperative ESWT results in comparable high union rates and good functional outcome. Due to the higher rate for a secondary intervention (plate removal), HCS might be preferable as first choice, whereas the scaphoid plate fixation should be reserved for recalcitrant (substantial bone loss, humpback deformity or failed prior surgical intervention) scaphoid nonunions.
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Affiliation(s)
- S Quadlbauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Ch Pezzei
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Beer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - V Moser
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - R Rosenauer
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S Salminger
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental Und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Department for Orthopedic Surgery and Traumatology, Paracelsus Medical University, 5020, Salzburg, Austria
| | - M Leixnering
- AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma and Replantation Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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Yang J, Zhang X, Liang W, Chen G, Ma Y, Zhou Y, Fen R, Jiang K. Efficacy of adjuvant treatment for fracture nonunion/delayed union: a network meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2022; 23:481. [PMID: 35597937 PMCID: PMC9123731 DOI: 10.1186/s12891-022-05407-5] [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: 01/03/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Fracture nonunion/delayed union seriously affects physical and mental health and quality of life. The aim of this study was to evaluate the relative efficacy of different adjuvant treatments for nonunion/delayed union by network meta-analysis. Methods A comprehensive search was performed to identify randomized controlled trials (RCTs) evaluating adjuvant treatment in the management of nonunion/delayed union. A network meta-analysis reporting on healing rate, healing time, and adverse effect (AE) outcomes was conducted to assess and compare different interventions. Results Thirty studies were included in the analysis. For the healing rate outcome, bone marrow aspirate (BMA) + autologous cancellous bone (ACB) was found to be significantly better than ACB alone (odds ratio: 0.12; 95% confidence interval: 0.03, 0.59). In the ranking results, BMA+ platelet-rich plasma (PRP) (96%), BMA + ACB (90%), and BMA alone (82%) showed relative advantages in the healing rate. Low-intensity pulsed ultrasonography (LIUS) intervention significantly shortened the healing time compared with ACB (SMD: -9.26; 95% CI: − 14.64, − 3.87). LIUS (100%), BMA + PRP (74%), and bone morphogenetic proteins (BMPs) (69%) have relative advantages. Compared with the control, electromagnetic field (EMF) (OR: 13.21; 95% CI: 1.58, 110.40) and extracorporeal shock wave (ESWT) (OR: 4.90; 95% CI: 1.38, 17.43) had a higher AE risk. Conclusions Among the current intervention strategies, BMA in combination with PRP and ACB can improve the healing rate of nonunion/delayed union. LIUS can significantly shorten the healing time. EMF and ESWT may have a high risk of AE. However, large-scale, well-designed studies are still needed to confirm the results. Trial registration Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05407-5.
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Affiliation(s)
- Jun Yang
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
| | - Xiangmin Zhang
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
| | - Wangbo Liang
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China.
| | - Guo Chen
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China.
| | - Yanbo Ma
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
| | - Yonghua Zhou
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
| | - Rong Fen
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
| | - Kaichang Jiang
- Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of TCM, 53 Nie er Rd, Yuxi, Yunnan Province, 653100, People's Republic of China
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Knobloch K. [Extracorporeal magnetotransduction therapy (EMTT) and high-energetic focused extracorporeal shockwave therapy (ESWT) as bone stimulation therapy for metacarpal non-union - a case report]. HANDCHIR MIKROCHIR P 2021; 53:82-86. [PMID: 33588496 DOI: 10.1055/a-1344-8126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This case report describes the combination of a high-energetic focused extracorporeal shockwave therapy (ESWT) with an extracorporeal magnetotransduction therapy (EMTT) in the treatment of a non-union of the metacarpal V improving bone healing within six weeks.
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