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Zakhia-Douaihy G, Issa M, Naja AS. Dorsal Approach with Low-Profile Plate in Treatment of Scaphoid Nonunion with Proximal Pole Avascular Necrosis: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00038. [PMID: 34293752 DOI: 10.2106/jbjs.cc.20.00370] [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: 11/14/2022]
Abstract
CASE Avascular necrosis (AVN) and nonunion are common complications encountered with scaphoid waist fractures. We present a case of a 23-year-old man presenting with a right scaphoid fracture nonunion associated with AVN of the proximal pole. He was treated with a 1,2 intercompartmental supraretinacular arterial bone graft (Zaidemberg technique) in combination with a dorsal plate yielding excellent functional and radiographic results. CONCLUSION Scaphoid waist fracture nonunion with AVN of the proximal pole is challenging to treat and combining the Zaidemberg technique along with dorsal plating allows for easy access and excellent healing.
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Affiliation(s)
| | - Mohamad Issa
- Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Orthopaedic Surgery Department, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Morgan SDJ, Sivakumar BS, Graham DJ. Scaphoid plating for recalcitrant scaphoid fractures: a systematic review. J Hand Surg Eur Vol 2021; 46:616-620. [PMID: 33861659 DOI: 10.1177/17531934211005637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We conducted a systematic review of scaphoid plating for recalcitrant scaphoid fractures using EMBASE, Pubmed, Cochrane and MEDLINE. Thirteen studies were included. Ninety-three per cent of cases reported were male with a mean age of 27 years. Bony union was reported in eleven studies and achieved in 72% to 100% of cases. Scaphoid plates showed no significant difference in union incidence compared with headless compression screws. Mean removal incidence of plates was 21%. Postoperative flexion-extension arc was 119°. Grip strength improved by 14% postoperatively over that before surgery. There was a general improvement in patient-reported outcome measures. Eighty-six per cent of reported participants returned to their previous work. In these clinical reports, plates frequently required removal more frequently than headless compression screws.
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Affiliation(s)
| | - Brahman S Sivakumar
- Australian Research Collaboration on the Hand (ARCH), Australia.,Royal North Shore Hospital, St Leonards, NSW, Australia.,Hornsby Ku-Ring-Gai Hospital, Sydney, NSW, Australia
| | - David J Graham
- Gold Coast University Hospital, Southport, QLD, Australia.,Australian Research Collaboration on the Hand (ARCH), Australia
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Hong J, Choi YR, Koh IH, Oh WT, Shin J, Kang HJ. Headless screw fixation through the dorsal rough surface for proximal-pole scaphoid-nonunion: a report of 15 patients. J Hand Surg Eur Vol 2020; 45:965-973. [PMID: 32009496 DOI: 10.1177/1753193420903672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Clinical outcomes of the dorsal-retrograde headless screw-fixation technique in 15 patients with proximal scaphoid nonunion are presented. In this technique, screws are inserted from the dorsal rough surface of the scaphoid, located between the dorsal ridge and scaphoid-trapezium-trapezoid joint. Fifteen patients underwent osteosynthesis with this technique with iliac bone graft. Seven patients required primary surgery, and eight patients with a history of failed operation required revision surgery. Among 15 patients, 13 achieved union and two with persistent nonunion were asymptomatic with average follow-up of 24 months (range 14-57). Mean time to union was 20 weeks (range 12-40). Our experience with the dorsal-retrograde headless screw fixation technique has shown encouraging results for the treatment of proximal-scaphoid nonunion, especially in revision surgery wherein secure fixation of the small proximal fragments can be difficult using conventional anterograde techniques.Level of evidence: IV.
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Affiliation(s)
- JungJun Hong
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jucheol Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Turow A, Phadnis J, Bain GI. A new radiographic view of the scaphotrapeziotrapezoid joint-a cadaveric study. Skeletal Radiol 2019; 48:1899-1904. [PMID: 31104145 DOI: 10.1007/s00256-019-03222-z] [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: 08/19/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The scaphotrapeziotrapezoid joint (STTJ) has a complex osseous and ligamentous anatomy. Precise radiographic assessment is paramount when assessing osteoarthritic, post-traumatic, or post-operative patients. There has been no described technique to image the STTJ without any wrist movement, unobscured by the rest of the carpus. The aim of this study was to define an optimal radiographic method to assess the STTJ while maintaining the wrist in neutral position. METHODS Computer tomography 3-D reconstructions of three uninjured wrists were initially used to determine an approximate beam angle. Serial radiographs of 12 cadaveric wrists were taken. The forearms were positioned in varying degrees of pronation and supination. The beam angle was concurrently adjusted to varying degrees of caudal tilt. From the images obtained, we assessed if the adjacent carpus obscured the view of the STTJ. RESULTS Optimal STTJ imaging was in the semi-pronated wrist position with the X-ray beam tilted caudal. We found that the STTJ was best visualized at 48° supination from a fully pronated wrist and a caudal beam angle of 22°. CONCLUSIONS The described wrist and beam orientation can aid in achieving an unobstructed view of the STTJ with little technical effort. This can aid in imaging ambulatory patients where symptoms prevent using other imaging techniques as well as patients in the operating room where imaging timing can be critical.
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Affiliation(s)
- Arthur Turow
- Flinders University of South Australia, Adelaide, Australia. .,Brighton & Sussex University Hospitals, Brighton, UK.
| | - Joideep Phadnis
- Brighton & Sussex University Hospitals, Brighton, UK.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Gregory I Bain
- Flinders University of South Australia, Adelaide, Australia.,Brighton & Sussex University Hospitals, Brighton, UK
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5
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Abstract
Internal fixation of the scaphoid using a plate has been reported in the literature as far back as 1977. Recently, a specific plate designed for scaphoids has been developed, which provides considerably more buttress support than intramedullary headless screws, and offers a reliable method of rigid internal fixation for complex fractures. Indications to use such a plate include complex acute fractures, such as those with significant waist comminution or steep reverse oblique fractures, and complex nonunions with central bone loss resulting from failed previous headless screw fixation. This is now the authors' preferred treatment for these injuries.
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Affiliation(s)
- Feiran Wu
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Wigan WN6 9EP, UK
| | - Chye Yew Ng
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Wigan WN6 9EP, UK
| | - Mike Hayton
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Wigan WN6 9EP, UK.
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Mehling IM, Arsalan-Werner A, Wingenbach V, Seegmüller J, Schlageter M, Sauerbier M. Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 2019; 139:1161-1169. [PMID: 31123820 DOI: 10.1007/s00402-019-03196-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies. MATERIALS AND METHODS Between March 2010 and December 2014, 20 patients (age range 16-59 years) were treated with scaphoid locking plate osteosynthesis. In 17 cases it was due to scaphoid nonunion or delayed union and in three cases to treat a complex multi-fragmentary fracture of the scaphoid. Most of the initial fractures were located either in the proximal third (n = 9) or the middle third (n = 8) of the scaphoid. RESULTS Mean follow-up was 14.6 ± 8.9 months (range 2-30 months). All three scaphoid fractures (100%) showed bony healing in the CT scan after 2.7 ± 0.6 months. 15 of 17 (88.2%) patients with scaphoid nonunion demonstrated bony healing in the latest CT scan at an average of 6.2 ± 8.1 months (range 2-11 months) after scaphoid reconstruction. Range of motion (extension/flexion) was 104° ± 18.4° (range 80°-150°) and about one third less than the unaffected side. The average grip strength averaged 38.2 kg on the operated side and 44.1 kg on the unaffected side after surgery. 13 plates (65%) had to be removed due to impaction of the plate or protrusion of the screws. CONCLUSIONS This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.
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Affiliation(s)
- Isabella M Mehling
- Division for Hand Surgery, St. Vincent Hospital Hanau, Am Frankfurter Tor 19, 63450, Hanau, Germany.
| | - A Arsalan-Werner
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - V Wingenbach
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - J Seegmüller
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Schlageter
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
| | - M Sauerbier
- Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany.,Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany
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Esteban-Feliu I, Barrera-Ochoa S, Vidal-Tarrason N, Mir-Simon B, Lluch A, Mir-Bullo X. Volar Plate Fixation to Treat Scaphoid Nonunion: A Case Series With Minimum 3 Years of Follow-Up. J Hand Surg Am 2018; 43:569.e1-569.e8. [PMID: 29358010 DOI: 10.1016/j.jhsa.2017.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 10/20/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Several options exist for treating scaphoid nonunion. For selected cases, some authors recommend using a volar buttress plate. The aim of the study was to report the clinical and radiological outcomes achieved at a minimum of 3 years' follow-up of treating scaphoid nonunion with a scaphoid volar plate. METHODS We retrospectively reviewed 15 patients with symptomatic scaphoid nonunion treated with scaphoid plate osteosynthesis and a bone graft from the volar aspect of the distal radius between January 2011 and November 2013. The patients' average age was 32 years (range, 21-62 years). No patient had undergone previous scaphoid surgery. Clinical assessments included wrist range of motion (ROM), grip strength, and a 10-point visual analog scale rating of pain. Further subjective assessment was performed using validated measurement tools. All patients underwent plain radiography with 6 different views and computed tomography before and after surgery. The scapholunate angle was measured to evaluate carpal alignment. RESULTS The mean follow-up period was 42 months (range, 36-51 months). Bone union was obtained in 13 of 15 patients (87%) at an average of 5 months (range, 3-8 months) after surgery. Significant improvements in the scapholunate angle and visual analog scale pain score were observed. However, both wrist ROM and grip strength remained significantly decreased relative to the opposite side (62% and 55% of normal, respectively). Four patients experienced hardware complications: plate breakage (1 scaphoid) and screw back-out (3 scaphoids). Impingement between the radial styloid and the scaphoid plate was identified in 6 patients. Five patients required additional surgery to remove the plate. CONCLUSIONS Our study indicates unsatisfactory results treating scaphoid nonunion with a volar scaphoid plate. Although the rate of union was comparable with that of other series, we noted more complications. We are concerned about both the high proportion of hardware complications and required secondary surgical procedures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ignacio Esteban-Feliu
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hand Surgery and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, ICATME, Barcelona, Spain
| | - Sergi Barrera-Ochoa
- Hand Surgery and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, ICATME, Barcelona, Spain; Department of Pediatric Hand Surgery and Microsurgery, Universitat de Barcelona, Barcelona, Spain; Department of Pediatric Orthopedic Surgery, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Vidal-Tarrason
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Bernat Mir-Simon
- Department of Surgery, UD-Vall d'Hebron School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Medcom Advance SA, Viladecans, Barcelona, Spain
| | - Alex Lluch
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hand Surgery, Institut Kaplan, Barcelona, Spain
| | - Xavier Mir-Bullo
- Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Hand Surgery and Microsurgery Unit, Hospital Universitari Quiron-Dexeus, ICATME, Barcelona, Spain
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Mandaleson A, Tham SK, Lewis C, Ackland DC, Ek ET. Scaphoid Fracture Fixation in a Nonunion Model: A Biomechanical Study Comparing 3 Types of Fixation. J Hand Surg Am 2018; 43:221-228. [PMID: 29132789 DOI: 10.1016/j.jhsa.2017.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 08/15/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Union of a scaphoid fracture after fixation is influenced by various factors, one of which is fracture stability. This study aims to compare the biomechanical stability of 3 different types of scaphoid fracture fixation in a scaphoid nonunion model. METHODS Thirty cadaveric scaphoid specimens were assigned to one of 3 different fixation groups: (1) single 3.0-mm compression screw, (2) two 2.2-mm screws, and (3) scaphoid plate. A 3-mm volar wedge osteotomy was created at the scaphoid waist to simulate a nonunion model. The primary outcome measure was load to failure, whereas secondary outcome measures were load to 2-mm displacement, energy absorbed, stiffness, and mode of failure, recorded by video and retrieval analysis. RESULTS There was a significantly lower load to failure in the single screw construct compared with that in the double screw (mean difference 187.2 N) and plate fixation constructs (mean difference 150.7 N). The mean load to 2-mm displacement in the single screw construct (91.5 N) was also significantly lower than that in the double screw (181.8 N) and plate fixation constructs (197.2 N). There was a significantly lower stiffness with the single screw fixation compared with that of the double screws (mean difference 85.4 N/mm), and lower energy absorbed with single screws when compared with that of double screws (mean difference 386.5 mJ) and when compared with plate fixation (mean difference 270.8 mJ). CONCLUSIONS In this biomechanical study comparing fixation methods using a model of scaphoid nonunion with bone loss, we found that double screws or plate fixation demonstrated significantly greater stability, stiffness, and energy absorption when compared with a single compression screw. We found no discernible differences between double screw fixation and the plate groups. CLINICAL RELEVANCE The use of double screws or plate fixation in a nonunion setting may allow accelerated rehabilitation without compromise to fracture stability.
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Affiliation(s)
- Avanthi Mandaleson
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - Stephen K Tham
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent's Institute, Melbourne, Victoria, Australia; Victorian Hand Surgery Associates, Fitzroy, Australia; Department of Surgery, Monash Medical Centre, Monash University, Clayton, Australia
| | - Craig Lewis
- Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - David C Ackland
- Department of Mechanical Engineering, University of Melbourne, Parkville, Australia
| | - Eugene T Ek
- Division of Hand Surgery, Department of Orthopaedics, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St Vincent's Institute, Melbourne, Victoria, Australia; Department of Surgery, Monash Medical Centre, Monash University, Clayton, Australia; Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia.
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9
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Schormans PMJ, Brink PRG, Poeze M, Hannemann PFW. Angular Stable Miniplate Fixation of Chronic Unstable Scaphoid Nonunion. J Wrist Surg 2018; 7:24-30. [PMID: 29383272 PMCID: PMC5788750 DOI: 10.1055/s-0037-1603202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
Background Around 5 to 15% of all scaphoid fractures result in nonunion. Treatment of long-lasting scaphoid nonunion remains a challenge for the treating surgeon. Healing of scaphoid nonunion is essential for prevention of scaphoid nonunion advanced collapse and the subsequent predictable pattern of radiocarpal osteoarthritis. Purpose The purpose of this study was to investigate the feasibility of fixation of the scaphoid nonunion with a volar angular stable miniplate and cancellous bone grafting. We hypothesized that this technique could be successful, even in patients with previous surgery for nonunion and in patients with a long duration of nonunion. Patients and Methods A total of 21 patients enrolled in a single-center prospective cohort study. Healing of nonunion was assessed on multiplanar computed tomography scan of the wrist at a 3-month interval. Functional outcome was assessed by measuring grip strength, range of motion, and by means of the patient-rated wrist and hand evaluation (PRWHE) questionnaire. Results During follow-up, 19 out of 21 patients (90%) showed radiological healing of the nonunion. The range of motion did not improve significantly. Postoperative PRWHE scores decreased by 34 points. Healing occurred regardless of the length of time of the nonunion (range: 6-183 months) and regardless of previous surgery (38% of patients). Conclusion Volar angular stable miniplate fixation with autologous cancellous bone grafting is a successful technique for the treatment of chronic unstable scaphoid nonunion, even in patients with long-lasting nonunion and in patients who underwent previous surgery for a scaphoid fracture. Rotational interfragmentary stability might be an important determining factor for the successful treatment of unstable scaphoid nonunion. Level of Evidence Level IV.
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Affiliation(s)
- Philip M. J. Schormans
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter R. G. Brink
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Abstract
Acute scaphoid fractures are common wrist injuries that continue to elicit debate from surgeons regarding the most appropriate diagnostic and management algorithms. This review will examine the current literature and trends, in an attempt to provide the reader with an evidence-based discussion regarding current controversies of interest to clinicians. In addition, an attempt will be made to provide recommendations for the best treatment practices for acute scaphoid fractures.
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Affiliation(s)
- Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, University of Western Ontario, London, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, University of Western Ontario, London, Ontario, Canada
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