1
|
Prommersberger KJ, Dimitrova P, Kalb K, Mühldorfer-Fodor M. [Fractures and Non-Unions of the Scaphoid: Our preferred surgical Approaches]. HANDCHIR MIKROCHIR P 2022; 54:381-388. [PMID: 36070780 DOI: 10.1055/a-1912-5419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This article describes our algorithm for approaching and fixing scaphoid fractures and non-unions.
Collapse
Affiliation(s)
| | - Polina Dimitrova
- Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Klinik Tübingen, Tübingen, Germany
| | - Karlheinz Kalb
- Klinik für Handchirurgie, Rhön Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | | |
Collapse
|
2
|
Dodds SD, Zalikha AK, Rush AJ, Fullerton N. A Retrospective Review of Differences in Complication Rates between Dorsal Percutaneous and Mini-Open Surgical Fixation of Scaphoid Fractures. J Wrist Surg 2021; 10:42-47. [PMID: 33552694 PMCID: PMC7850805 DOI: 10.1055/s-0040-1716511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Objective We retrospectively reviewed the complications of 80 cases of scaphoid screw fixation in acute fractures and early nonunions comparing dorsal percutaneous and mini-open approaches. Methods We performed a chart review of all patients who underwent surgical fixation of a scaphoid fracture or a nascent nonunion using a dorsal percutaneous or dorsal mini-open technique by a single surgeon. We collected data on patient demographics, including age and smoking status, time to surgery, fracture type, union, and the major and minor complications that occurred in each group. Fisher's exact tests were used to compare the complication rates between the groups. Results We identified 80 patients who underwent surgical fixation. Of these, 44 underwent percutaneous fixation and 36 underwent mini-open fixation. All fractures went on to heal. There was a total of five complications identified. There were no major complications in the percutaneous group, but one major complication in the mini-open group (a delayed union that eventually healed at 6 months). There were two minor complications in each group. There was no statistically significant difference in total, major, or minor complication rates between the groups. Conclusions This study suggests that a dorsal percutaneous surgical technique for scaphoid fracture repair does not affect the complication rate despite prior literature to the contrary. Both techniques analyzed produce excellent rates of union with very low complication rates. Surgeon-specific technique rather than operative approach or exposure may be responsible for previously reported complication rates in the fixation of scaphoid fractures. Level of Evidence This is a level III, therapeutic study.
Collapse
Affiliation(s)
- Seth D. Dodds
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Abdul K. Zalikha
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Augustus J. Rush
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| | - Natalia Fullerton
- Department of Orthopaedics, University of Miami, Miller School of Medicine, Miami, Florida
| |
Collapse
|
3
|
Xu Y, Xu Y, He X, Li C, Yang X, Zhang X, Zhao W. [Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:671-675. [PMID: 32538554 DOI: 10.7507/1002-1892.201911013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation. Methods Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert's classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score. Results All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation ( P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation ( P<0.05). There was no significant difference between at 6 months and last follow-up ( P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%. Conclusion Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.
Collapse
Affiliation(s)
- Yujian Xu
- The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - Yongqing Xu
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xiaoqing He
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Chuan Li
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xi Yang
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xulin Zhang
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Wanqiu Zhao
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| |
Collapse
|
4
|
Comparison of volar versus dorsal screw fixation for scaphoid waist fractures: A finite element analysis. Orthop Traumatol Surg Res 2018; 104:1107-1113. [PMID: 30179724 DOI: 10.1016/j.otsr.2018.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/12/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Scaphoid waist fractures may be fixed through volar or dorsal screw fixation. However, there is no consensus on which surgical fixation method should be performed. The purpose of this study was to compare volar versus dorsal screw fixation of scaphoid waist fractures under physiological loading conditions utilizing finite element analysis. METHODS A transverse scaphoid waist fracture (Herbert type B2) model was fixed with a headless cannulated compression screw using either a volar or dorsal approach. Displacement and rotation of the fragments and stress analysis on the scaphoid bone and screw were analyzed in the models using 3-D finite element analysis in three different wrist positions; total extension (TE), neutral (N) and total flexion (TF). RESULTS Displacement of the fracture gap in volar fixation in all planes (x, y, z) was less than in dorsal fixation in the TF and N positions. Furthermore, rotational stability was stronger in volar fixation in all planes and wrist positions. von Mises stress values were concentrated on the proximal fragment in all wrist positions. CONCLUSIONS Although both volar and dorsal fixation techniques can be preferred in Herbert type B2 fractures, results of this finite element analysis suggest that centrally placed volar compression screw fixation may be biomechanically advantageous over dorsal screw fixation. LEVEL OF EVIDENCE I.
Collapse
|
5
|
DE MORAES VINÍCIUSYNOE, RUFF PRISCILAFRANTZ, FERNANDES CARLOSHENRIQUE, SANTOS JOÃOBAPTISTAGOMESDOS, BELLOTI JOÃOCARLOS, FALOPPA FLÁVIO. APPLICABILITY OF RANDOMIZED TRIALS IN HAND SURGERY: SURVEY STUDY. ACTA ORTOPEDICA BRASILEIRA 2018; 26:154-157. [PMID: 30038536 PMCID: PMC6053970 DOI: 10.1590/1413-785220182603170123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the applicability of randomized clinical trials and whether certain factors (surgeon experience/journal impact factor) influence their applicability. METHODS In this survey study we used the Pubmed/Medline database to select 32 consecutive randomized clinical trials published between 2013 and 2015, involving hand surgery (high/low impact). These studies were independently assessed by 20 hand surgeons (with more or less than 10 years of practice) who answered 4 questions regarding their applicability. Agreement was assessed using Cohen's kappa and comparison of proportions via chi-square statistics. P-value <5% constituted statistical significance. RESULTS A total of 640 evaluations were produced, generating 2560 responses. A weak correlation was observed between less and more experienced respondents (kappa <0.2; range 0.119-0.179). Applicability between the least and most experienced respondents was similar (p = 0.424 and p = 0.70). Stratification by journal impact factor showed no greater propensity of applicability (p = 0.29) for any of the groups. CONCLUSIONS Low agreement was found between the respondents for the applicability of the randomized studies. Surgeon experience and journal impact do not seem to influence this decision. Level of Evidence II, Prospective comparative study.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Kang KB, Kim HJ, Park JH, Shin YS. Comparison of Dorsal and Volar Percutaneous Approaches in Acute Scaphoid Fractures: A Meta-Analysis. PLoS One 2016; 11:e0162779. [PMID: 27611594 PMCID: PMC5017637 DOI: 10.1371/journal.pone.0162779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/29/2016] [Indexed: 11/17/2022] Open
Abstract
The dorsal approach allows better central screw placement along the long axis of the scaphoid compared with the volar approach in managing acute scaphoid fractures. However, it is unclear whether the dorsal approach leads to better clinical outcomes than the volar approach. This meta-analysis compared clinical outcomes, including the incidence of nonunion, postoperative complications, overall functional outcome, postoperative pain, grip strength, and range of wrist motion, between the dorsal and volar percutaneous approaches for the management of acute scaphoid fractures. Seven studies met the criteria for inclusion in the meta-analysis. The proportion of patients who developed nonunion (OR 0.74, 95% CI: 0.21 to 2.54; P = 0.63) and postoperative complications (OR 1.05, 95% CI: 0.45 to 2.44; P = 0.91) did not differ significantly between the dorsal and volar approaches. Both approaches also led to similar results in terms of overall functional outcome (95% CI: -0.39 to 0.22; P = 0.57), postoperative pain (95% CI: -0.52 to 0.46; P = 0.92), grip strength (95% CI: -4.56 to 1.02; P = 0.21), flexion (95% CI: -2.86 to 1.13; P = 0.40), extension (95% CI: -1.17 to 2.67; P = 0.44), and radial deviation (95% CI: -1.94 to 2.58; P = 0.78). However, ulnar deviation (95% CI: -7.48 to 0.05; P = 0.05) was significantly greater with the volar approach. Thus, orthopedic surgeons need to master both the dorsal and volar percutaneous approaches because not all acute scaphoid fractures can be dealt with completely with one approach.
Collapse
Affiliation(s)
- Kyu-Bok Kang
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae-Hong Park
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| |
Collapse
|
8
|
Shen L, Tang J, Luo C, Xie X, An Z, Zhang C. Comparison of operative and non-operative treatment of acute undisplaced or minimally-displaced scaphoid fractures: a meta-analysis of randomized controlled trials. PLoS One 2015; 10:e0125247. [PMID: 25942316 PMCID: PMC4420279 DOI: 10.1371/journal.pone.0125247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
Background Traditionally, acute undisplaced or minimally-displaced scaphoid fractures are treated by casting in short- or long-arm casts. Although reports have shown that operative treatment is safe, effective and produces satisfactory results, outcomes from current studies comparing these two methods are questionable. The aim of this meta-analysis was to evaluate the effects of operative versus non-operative treatment for acute undisplaced or minimally-displaced scaphoid fractures in adults. Methods Computerized searches were performed without language restrictions and all randomized controlled studies providing information on the effects of operative versus non-operative treatment on the outcomes of acute undisplaced or minimally-displaced scaphoid fractures were included. The weighted and standard mean difference (WMD and SMD) or the relative risk (RR) were calculated for continuous or dichotomous data respectively. Results A total of six studies reported in seven publications were included, representing data on 340 fractures. Meta-analysis indicated that operative treatment resulted in significantly better functional outcomes in the short term when compared with non-operative treatment. Consistently, patients who accepted surgery had a more rapid return to work. Further, surgery was advantageous in preventing delayed union of the fractures, a finding supported by the results of analysis of the time to fracture union. A number-needed-to-treat analysis revealed that more than 20 patients would have to undergo operative treatment to prevent one delayed union. Conclusion Acute undisplaced or minimally-displaced scaphoid fractures demonstrate faster recovery with operative treatment; however, the current meta-analysis does not provide evidence supporting the routine use of operative treatment for all acute undisplaced or minimally-displaced scaphoid fractures.
Collapse
Affiliation(s)
- Longxiang Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
| | - Jianfei Tang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
| | - Congfeng Luo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
| | - Xuetao Xie
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
- * E-mail:
| | - Zhiquan An
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
| | - Changqing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, PR China
| |
Collapse
|