1
|
Bari M, Konchada S, Pradhan S, Gulia A, Sandeep B, Goyal D, kaushik S, Dhingra K. Management of Scaphoid Nonunion (SNU) With Ilizarov Ring Fixator Using Two Olive Wire Compression Without Bone Grafting: A Case Series. Cureus 2022; 14:e31646. [DOI: 10.7759/cureus.31646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/19/2022] Open
|
2
|
Eda Y, Yoshii Y, Ishii T. Scaphoid nonunion with DISI deformity treated in a two-stage operation with the Ilizarov mini fixator: A case report. Trauma Case Rep 2022; 41:100688. [PMID: 35942322 PMCID: PMC9356297 DOI: 10.1016/j.tcr.2022.100688] [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] [Accepted: 07/30/2022] [Indexed: 12/03/2022] Open
Abstract
Scaphoid nonunion causes humpback deformity and dorsal intercalated segment instability (DISI) deformity due to dorsal rotation of the proximal scaphoid fragment. In the treatment of scaphoid nonunion, it is important to not only achieve bone union, but also to improve DISI deformity and carpal bone alignment in order to attenuate pain, increase the range of motion, and prevent the development of osteoarthritis. We encountered a case of DISI deformity caused by the long-term neglect of scaphoid nonunion that was treated in a two-stage operation with the Ilizarov mini fixator. A 28-year-old male had been injured during a soccer game 10 years ago. Although he had wrist pain, he did not visit a hospital. This led to chronic scaphoid nonunion with DISI deformity. Since 10 years had passed from the initial injury, DISI deformity was considered to be difficult to correct using a single stage procedure. Therefore, a two-stage operation was performed. The Ilizarov mini fixator was used to gradually correct DISI deformity in the first stage, and screw fixation with bone grafting was performed in the second stage. Difficulties are associated with achieving good clinical results in cases of long-term scaphoid nonunion. In cases of DISI deformity, it is important to correct the alignment of lunate dorsiflexion and the distal carpal row as well as achieve bone union. Although the Ilizarov external fixator has been used for scaphoid nonunion, it has not yet been applied to scaphoid nonunion with DISI deformity. The Ilizarov mini fixator may be useful to correct long-term deformities, and good results were obtained in the present case. It represents an option for the treatment of scaphoid nonunion with DISI deformity.
Collapse
Affiliation(s)
| | - Yuichi Yoshii
- Corresponding author at: Tokyo Medical University Ibaraki Medical Center, Department of Orthopaedic Surgery, 3-20-1 Chuo, Ami, Inashiki, Ibaraki 300-0395, Japan.
| | | |
Collapse
|
3
|
Schuind F, Moungondo F, El Kazzi W. Prognostic factors in the treatment of carpal scaphoid non-unions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:3-9. [DOI: 10.1007/s00590-016-1886-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/24/2016] [Indexed: 01/22/2023]
|
4
|
Bumbaširević M. Scaphoid nonunion: special edition. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:1-2. [PMID: 27848020 DOI: 10.1007/s00590-016-1872-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Marko Bumbaširević
- Clinic of Orthopedic Surgery and Traumatology, Clinical Centre of Serbia, School of Medicine, University of Belgrade, 26 Visegradska Street, Belgrade, 11 000, Serbia.
| |
Collapse
|
5
|
Meisel E, Seal A, Yao CA, Ghiassi A, Stevanovic M. Management of scaphoid nonunion with iliac crest bone graft and K-wire fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:23-31. [DOI: 10.1007/s00590-016-1876-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
|
6
|
Ilizarov fixation for the treatment of scaphoid nonunion: a novel approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:41-51. [PMID: 27766431 DOI: 10.1007/s00590-016-1871-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft. DESIGN This is a prospective study of 20 consecutive patients in one center. PATIENTS AND METHODS This study included 20 patients (19 males) with a mean SNU duration of 14.5 months. Four patients had proximal pole, 15 had waist, and 1 had a distal SNU. Patients with carpal instability, humpback deformities, carpal collapse, avascular necrosis, and marked degenerative change were excluded. Following frame application, the treatment comprises three stages: The frame is distracted by 1 mm per day until the radiographs show a 2-3 mm opening at the SNU site (mean 10 days); the SNU site is compressed for 5 days, at a rate of 1 mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the wrist is then immobilized in the Ilizarov fixator for 8 weeks. RESULTS Radiographic (radiography and CT scan) and clinical bony union was achieved in all 20 patients after a mean of 90.3 days (70-130 days). All patients returned to their pre-injury occupations. Thirteen patients had excellent results, four good, and three fair, according to the Mayo wrist score. CONCLUSIONS In these selected patients, this technique safely achieved bony union without the need to open the SNU site and without the requirement of bone graft.
Collapse
|
7
|
Uesato R, Toh S, Hayashi Y, Maniwa K, Ishibashi Y. Non-vascularized bone grafting in scaphoid nonunion: principles and type of fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:11-21. [PMID: 27761662 DOI: 10.1007/s00590-016-1868-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/09/2016] [Indexed: 12/21/2022]
Abstract
In scaphoid fractures, delayed diagnosis and nonunion are fairly common as a result of several factors, including the difficulty of radiographic diagnosis of non-displaced fractures and underestimation of the injury by the patient. Main factors to consider when deciding treatment are the type of fracture and fracture stability. In the stable nonunion (Type D1 according to the Filan and Herbert classification, or linear type of Ikeda's classification), percutaneous screw fixation without bone graft is recommended. The indications of non-vascularized bone grafting are as follows: (1) arthroscopic cancellous bone graft in type D1 and cystic type of Ikeda's classification. (2) tricortical bone graft from the iliac crest in type D2 or D3 if the possibility of avascular necrosis of the proximal fragment is excluded. In this paper, our non-vascularized bone grafting for scaphoid nonunion would like to be described mainly about principles and type of fixation.
Collapse
Affiliation(s)
- Ryoko Uesato
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Satoshi Toh
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. .,Department of Orthopaedic Surgery, Hirosaki National Hospital, National Hospital Organization, Hirosaki, Japan.
| | - Yoshimitsu Hayashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Keiichiro Maniwa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
8
|
Somerson JS, Fletcher DJ, Srinivasan RC, Green DP. Compression screw fixation without bone grafting for scaphoid fibrous nonunion. Hand (N Y) 2015; 10:450-3. [PMID: 26330777 PMCID: PMC4551641 DOI: 10.1007/s11552-015-9741-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Bone graft is often recommended as an adjuvant for treatment of scaphoid nonunions. However, recent literature has suggested that fibrous nonunion may be suited to treatment with rigid fixation without bone grafting. This work reported on outcomes of compression screw fixation for established scaphoid fibrous nonunions without bone graft. METHODS Fourteen patients underwent surgical compression screw fixation without bone grafting of scaphoid fibrous nonunion between January 1, 2000, and December 31, 2012, with minimum follow-up until the time of clinical and radiographic healing. Fibrous nonunion of the scaphoid was defined as a scaphoid fracture with all of the following features: (1) persistent tenderness, (2) incomplete trabecular bridging on three X-ray views, (3) injury that had occurred at a minimum of 6 months prior to surgery, and (4) identification of fibrous union at the time of surgery. Outcomes were assessed with range of motion assessment, Disability of the Arm, Shoulder and Hand (DASH) scores, and plain radiographs. RESULTS Twelve of the 14 patients healed successfully, while two patients required secondary vascularized bone grafting. Both unhealed patients sustained proximal pole fractures and had a duration of ≥1 year from injury to surgery. Average time to healing was 4.4 ± 2.0 months. Average flexion was 73 ± 22° and average extension was 66 ± 22° postoperatively. Average grip strength was 90 ± 25 lbs on the operative side. Mean postoperative pain score was 1.4 (range, 0 to 7). Mean postoperative DASH score was 10.2 (range, 0 to 52). Increasing age and an interval from injury to surgery of >1 year correlated with worse DASH and pain scores. CONCLUSIONS Patients with fibrous scaphoid nonunion demonstrated good results with rigid fixation without bone grafting. Increasing age and >1-year interval between injury and surgery resulted in lower self-assessed outcomes. LEVEL OF EVIDENCE Therapeutic Level IV, retrospective case series.
Collapse
Affiliation(s)
- Jeremy S. Somerson
- />Department of Orthopaedics, University of Texas Health Science Center San Antonio, San Antonio, TX USA
| | - Daniel J. Fletcher
- />The Hand Center of San Antonio, 21 Spurs Lane, San Antonio, TX 78240 USA
| | | | - David P. Green
- />The Hand Center of San Antonio, 21 Spurs Lane, San Antonio, TX 78240 USA
| |
Collapse
|
9
|
Capitolunate Arthrodesis for Treatment of Scaphoid Nonunion Advanced Collapse (SNAC) Wrist Arthritis. J Hand Microsurg 2015; 7:79-86. [PMID: 26078508 DOI: 10.1007/s12593-015-0182-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/21/2015] [Indexed: 12/21/2022] Open
Abstract
The aim of the study was to evaluate results of capitolunate arthrodesis for the treatment of post traumatic degenerative SNAC wrist disorders. A capitolunate arthrodesis was performed on 12 patients, three women and nine men, of 44 years in average (28-66 years). Ten patients were manual workers; dominant side was involved in seven cases with no history of previous operation. Fixation of the arthrodesis was performed with headless compression screws. Patients were reviewed at 37.4 months of average follow up (range; 12-47 months). Mayo score equal to 82.8 points. Radiolunate and capitolunate angles were decreased of 6 and 8° respectively at the final follow up radiograph compared to preoperative values. The Ten manual worker patients were able to return to their previous professional activities and the other two patients were retired but they resume their sports and recreational activities. With the advent of headless compression screws the capitolunate arthrodesis gained a higher union rate, short operative time and short rehabilitation period. In the present study the capitolunate arthrodesis allowed restoring a stable functional wrist in the 12 patients reviewed. It is a satisfactory therapeutic alternative to four corners fusion for SNAC wrist with osteoarthritis.
Collapse
|
10
|
Fouly EH, Sadek AF, Amin MF. Distal capitate shortening with capitometacarpal fusion for management of the early stages of Kienböck's disease with neutral ulnar variance: case series. J Orthop Surg Res 2014; 9:86. [PMID: 25304759 PMCID: PMC4195980 DOI: 10.1186/s13018-014-0086-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background The aim of surgical management of Kienböck’s disease has been proposed to slow the progressive osteonecrosis and secondary carpal damage. The aim of this case series was to evaluate the results of a new technique, combining distal capitate shortening with capitometacarpal fusion for the treatment of Kienböck’s disease (Lichtman stage II or stage IIIA) in neutral ulnar variance patients. Methods From 2009 to 2012, 12 patients (mean age: 25 ± 7.6 years) were enrolled in this series. Radiological and clinical evaluations using the modified Mayo wrist scoring system were performed both pre-operatively and 12 months post-operatively. In addition, values of the scapho-capitate angle were evaluated both pre-operatively and 12 months post-operatively. The mean follow-up was 20.7 ± 11.2 months. Statistical analysis was performed for comparisons between pre-operative and post-operative findings with the use of paired sample T test, Pearson’s correlation, independent sample T test, and Spearman’s rho correlation. Statistical significance was determined to be present at p <0.05. Results All patients achieved bony union at the fusion site within a mean period of 11.5 ± 2.4 weeks. Regarding wrist pain, grip strength, total wrist arc of motion, practicing daily activities in a normal pattern, and the total modified Mayo wrist score, there were statistically significant differences between the pre-operative and post-operative results. For the differential arc of motion, the only non-significant results were at the ulnar/radial deviation range (p = 0.262). The mean pre-operative scapho-capitate angle was 29.75 ± 3.44 while the mean post-operative value was 33.67 ± 4.77 (p < 0.001). Both pre-operative and post-operative scapho-capitate angle values were positively correlated to post-operative pain, ulnar/radial deviation, and final score (p = 0.001, 0.027, 0.021 and p = 0.001, 0.004, 0.002, respectively). Other parameters had no correlation to this angle. Post-operative MRI (at 12 months follow-up) demonstrated better lunate revascularization in four patients; one of them was diagnosed as having Lichtman stage IIIA Kienböck’s disease. There were no patient-reported complications at the end of follow-up. Conclusions Distal capitate shortening combined with capitometacarpal fusion represents a new reliable method in the treatment of early stages of Kienböck’s disease with neutral ulnar variance.
Collapse
|
11
|
Sabharwal S, Fragomen A, Iobst C. What's new in limb lengthening and deformity correction. J Bone Joint Surg Am 2013; 95:1527-34. [PMID: 23965706 DOI: 10.2106/jbjs.m.00599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
| | | | | |
Collapse
|
12
|
Abstract
INTRODUCTION This is single centre retrospective review of a consecutive series of patients with scaphoid nonunion (SNU) treated using the Ilizarov technique without bone graft. Fifteen of the original 18 patients were available for clinical and radiological examination at a minimum follow-up of 5 years (range 5-10 years). An evaluation was made of the late functional results, satisfaction scores, residual symptoms, grip strength and the presence of radiocarpal and scaphoid degenerative changes. METHODS The series consisted of 15 patients; 14 males; 1 female, with a mean SNU duration of 15.7 months, and a mean age of 23.6 years. Patients with carpal instability, humpback deformity, carpal collapse, avascular necrosis or marked degenerative change, were excluded from this treatment method. Following frame application the treatment consisted of three stages: distraction, compression and immobilisation. The technique is detailed herein. RESULTS Radiographic (CT) and clinical bony union was achieved in all 15 patients after a mean of 88 days (70-130 days). Mean modified Mayo wrist scores initially improved from 21 preoperatively to 86 at previous review, and were 96 at a mean follow-up of 81 months (62-120 months), with excellent results in 10, and good results seen in 5 patients. At latest review the mean grip strengths had returned to 96% of the uninjured hand, and 7 patients had regained full strength; mean wrist flexion/extension arc of motion had also continued to improve to 136° from 131°. All patients returned to their pre-injury occupations and levels of activity at a mean of 117 days. Three patients suffered superficial K-wire infections, which resolved with oral antibiotics. One patient continues to suffer intermittent mild aching in the wrist. No patient suffered loss of scaphoid height, humpback deformity, DISI instability or collapse of the regenerate bone. CONCLUSION In these selected patients this technique safely achieved bony union without the need to open the SNU site and without the need for bone graft. These patients also had the capacity to continually improve their wrist function beyond 3 years following their treatment.
Collapse
Affiliation(s)
- Marko Bumbasirevic
- University of Belgrade, School of Medicine, Institute for Orthopaedic Surgery and Traumatology, Clinical Center of Serbia, Belgrade, Serbia.
| | - Henry D Atkinson
- Department of Trauma and Orthopaedics, North Middlesex University Hospital and London Sports Orthopaedics, Sterling Way N18 1QX, UK
| | - Aleksandar Lesic
- University of Belgrade, School of Medicine, Institute for Orthopaedic Surgery and Traumatology, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|