Scaphoid non-union can result in pain, altered wrist kinematics leading to a Scaphoid Non-union Advance Collapse, ultimately to symptomatic radio-carpal arthritis. Open techniques have their limitations. We describe the rationale, surgical technique and outcomes of our series of arthroscopic bone-grafting (ABG) and fixation of scaphoid non-union. We performed a prospective single-surgeon series of 22 consecutive patients with clinico-radiologically established scaphoid non-union between March 2015 and April 2019. Data was collected from Electronic Patient Records, Patient Archived Computer system (PACS) and hand therapy assessments. We collected demographic data including age, hand-dominance, occupation and mechanism of injury. The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH), Mayo wrist score, Patient Rated Wrist Evaluation (PRWE) and grip-strength measurements were collected preoperatively and at follow-up appointments.Abstract
Background
Methods
The aim of this study was to compare the results of Matti-Russe (MR) procedure and interpositional techniques (IT) in the management of scaphoid non-union. 50 scaphoid non-unions were included in this retrospective study. Demographics, initial management of fracture, location of non-union, time to surgery, procedure done and immobilisation time were recorded. Radiographs were analysed for union and deformity correction. Functional outcome was analysed using the Herbert's grading system. The mean age and time to surgery were 26.7 years and 15.9 months. Twenty-one patients had the MR procedure and twenty-nine patients had interpositional procedures with internal fixation. DISI was present in 17 patients. The mean postoperative change in the scapholunate angle with the MR procedure was 7.9° compared to 8.0° (p>0.05) for the IT procedures. Union rate was 76% for both procedures. The mean follow-up was 9.9 months. Functional results were Herbert 0 or 1 in 42 cases. The only significant prognostic variables were location of non-union and time to surgery. Similar deformity correction was achieved using both IT and MP procedures. MP procedure can be used in the management of scaphoid non-union even in the presence of deformity with good functional results.
Scaphoid fractures accounts for approximately 15% of all fractures of hand and wrist. Proximal pole fractures represent 10–20% of scaphoid fractures. Non –operative treatment shows high incidence of non-union and avascular necrosis. Surgical intervention with bone graft is associated with better outcome. The aim of this study was to evaluate the radiological and functional outcome of management of proximal pole scaphoid non-union with internal fixation and bone grafting. We included 35 patients with proximal pole scaphoid non-union (2008–2015). All patients underwent antegrade headless compression screw fixation and bone grafting at King's College Hospital, London (except one, who was fixed with Kirschner wire). 33 patients had bone graft from distal radius and two from iliac crest. Postoperatively patients were treated in plaster for 6–8 weeks, followed by splinting for 4–6 weeks and hand physiotherapy. All the patients were analysed at the final follow-up using DASH score and x-rays. Mean age of the patients was 28 years (20–61) in 32 men and 3 women. We lost three patients (9%) to follow up. At a mean follow up of 16 weeks (12–18) twenty three patients (66%) achieved radiological union. All patients but three (91%) achieved good functional outcome at mean follow up of 14 weeks (10–16). A good functional outcome can be achieved with surgical fixation and bone graft in proximal pole scaphoid fractures non-union. Pre-operative fragmentation of proximal pole dictates type of fixation (screw or k wire or no fixation). There was no difference in outcome whether graft was harvested from distal radius or iliac crest.
Intraoperative range of motion (ROM) radiographs are routinely taken during scaphoidectomy and four corner fusion surgery (S4CF) at our institution. It is not known if intraoperative ROM predicts postoperative ROM. We hypothesize that patients with a greater intra-operativeROM would have an improved postoperative ROM at one year, but that this arc would be less than that achieved intra- operatively. We retrospectively reviewed 56 patients that had undergone S4CF at our institution in the past 10 years. Patients less than 18, those who underwent the procedure for reasons other than arthritis, those less than one year from surgery, and those that had since undergone wrist arthrodesis were excluded. Intraoperative ROM was measured from fluoroscopic images taken in flexion and extension at the time of surgery. Patients that met criteria were then invited to take part in a virtual assessment and their ROM was measured using a goniometer. T-tests were used to measure differences between intraoperative and postoperative ROM, Pearson Correlation was used to measure associations, and linear regression was conducted to assess whether intraoperative ROM predicts postoperative ROM. Nineteen patients, two of whom had bilateral surgery, agreed to participate. Mean age was 54 and 14 were male and 5 were male. In the majority, surgical indication was scapholunate advanced collapse; however, two of the participants had
Introduction. It is well established that non-union of the scaphoid requires operative intervention to achieve stable union, restore scaphoid anatomy and prevent further degenerative change. Acutrak screw has been shown to have better biomechanical compression properties than the Herbert screw in the laboratory setting. The aims of the study were to assess the rate of union, the functional outcome and post- operative complications of patients with the two different screw systems. Methods. A retrospective review of the patients who had undergone surgery for non-union of scaphoid treated by a single surgeon. The first group consisted of 61 patients who were treated with Herbert screw and iliac crest bone graft between July 1996 and June 2000. The rate and time to union were assessed clinically and radiologicaly. Their post-operative functional outcome was assessed with modified Mayo wrist score. Results were compared to second group of 71 patients treated with Acutrak screw plus iliac crest bone graft between July 2000 and December 2005. Results. The mean ages of patients (25yrs in Herbert Vs 27yrs in Acutrak) were similar in both groups. The mean time interval between injury and surgery was 12.2months for Herbert group and 17months in Acutrak group. Herbert group had 77% (47) union rate compared to 93% (66) for the Acutrak group. There was persistent nonunion in 14 (22.9%) and 5 (7%) patients in Herbert and Acutrak groups respectively. Functional outcome were excellent in 41% of cases, good in 26% of cases, fair in 22%, and poor in 11 % of cases in Herbert group. For Acutrak group, the outcome score were better with excellent 60% of cases, good in 25%, fair in 10% and poor in 5% of the cases. Wrist fusion was performed in 4 and 1 cases for Herbert and Acutrak group respectively due to progressive wrist pain. Conclusion. Acutrak screw offer better union rate and functional outcome following surgery for
