Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment?
| Title: | Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment? |
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| Authors: | Mani, K. C. Kapil, Acharya, Parimal |
| Source: | International Orthopaedics; May2018, Vol. 42 Issue 5, p1099-1106, 8p |
| Subject Terms: | BONE grafting, HEALTH outcome assessment, SCAPHOID bone, SCREW caps, NECROSIS |
| Abstract: | Purpose: Conventional bone grafting and Herbert screw fixation give satisfactory results for scaphoid nonunion; however, vascularized bone grafting has superior results, especially in the case of avascular necrosis of proximal fragment. Vascularized bone grafting is technically more demanding with small error of margin, problems of getting the appropriate graft, fixation and incorporation, and requires longer duration for wrist immobilization.Methods: Forty-five patients of scaphoid nonunion were treated by cancellous bone grafting, cortex containing graft if required and Herbert screw fixation. Functional outcomes were assessed at the latest follow up after surgery (minimum one year after surgery).Results: The average pre-operative and post-operative scapho-lunate angle, grip strength, flexion-extension movement, radio-ulnar movement, scaphoid index and modified mayo score were improved from 49.60 ± 6.40° (37-66) to 36.26 ± 4.73° (range 28-46), 20.66 ± 3.17 kg (15-27) to 31.11 ± 3.29 kg (range 25-40), 78.57 ± 14.22° (45-110) to 132.86 ± 13.90° (100-165), 30.06 ± 6.06° (20-44) to 44.95 ± 6.37°(range 35-59), 0.66 ± 0.076 (0.55-0.79) to 0.60 ± 0.065 (range 0.49-0.73) and 58.66 ± 5.24 (50-70) to 84.37 ± 5.01 (range 75-95), respectively, with |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment? – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Mani%2C+K%2E+C%2E+Kapil%22">Mani, K. C. Kapil</searchLink><br /><searchLink fieldCode="AR" term="%22Acharya%2C+Parimal%22">Acharya, Parimal</searchLink> – Name: TitleSource Label: Source Group: Src Data: International Orthopaedics; May2018, Vol. 42 Issue 5, p1099-1106, 8p – Name: Subject Label: Subject Terms Group: Su Data: <searchLink fieldCode="DE" term="%22BONE+grafting%22">BONE grafting</searchLink><br /><searchLink fieldCode="DE" term="%22HEALTH+outcome+assessment%22">HEALTH outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22SCAPHOID+bone%22">SCAPHOID bone</searchLink><br /><searchLink fieldCode="DE" term="%22SCREW+caps%22">SCREW caps</searchLink><br /><searchLink fieldCode="DE" term="%22NECROSIS%22">NECROSIS</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Purpose: Conventional bone grafting and Herbert screw fixation give satisfactory results for scaphoid nonunion; however, vascularized bone grafting has superior results, especially in the case of avascular necrosis of proximal fragment. Vascularized bone grafting is technically more demanding with small error of margin, problems of getting the appropriate graft, fixation and incorporation, and requires longer duration for wrist immobilization.Methods: Forty-five patients of scaphoid nonunion were treated by cancellous bone grafting, cortex containing graft if required and Herbert screw fixation. Functional outcomes were assessed at the latest follow up after surgery (minimum one year after surgery).Results: The average pre-operative and post-operative scapho-lunate angle, grip strength, flexion-extension movement, radio-ulnar movement, scaphoid index and modified mayo score were improved from 49.60 ± 6.40° (37-66) to 36.26 ± 4.73° (range 28-46), 20.66 ± 3.17 kg (15-27) to 31.11 ± 3.29 kg (range 25-40), 78.57 ± 14.22° (45-110) to 132.86 ± 13.90° (100-165), 30.06 ± 6.06° (20-44) to 44.95 ± 6.37°(range 35-59), 0.66 ± 0.076 (0.55-0.79) to 0.60 ± 0.065 (range 0.49-0.73) and 58.66 ± 5.24 (50-70) to 84.37 ± 5.01 (range 75-95), respectively, with <italic>P</italic> value <0.001. Based on modified mayo score, 21 (46.7%) patients had excellent results, 19 (42.2%) had good results, 4 (8.9%) had fair results and one patient (2.2%) had poor results.Conclusion: Bone grafting and Herbert screw fixation provides a good option for treatment of scaphoid nonunion, especially in the absence of avascular necrosis of proximal fragment. More importantly, vascularized bone grafting in all scaphoid nonunion may not be necessary and could otherwise have been united uneventfully by this technique. However, avascular necrosis of proximal fragment must be ruled out pre-operatively as well as intra-operatively. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of International Orthopaedics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1007/s00264-017-3590-3 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 8 StartPage: 1099 Subjects: – SubjectFull: BONE grafting Type: general – SubjectFull: HEALTH outcome assessment Type: general – SubjectFull: SCAPHOID bone Type: general – SubjectFull: SCREW caps Type: general – SubjectFull: NECROSIS Type: general Titles: – TitleFull: Scaphoid nonunion: does open reduction, bone grafting and Herbert screw fixation justify the treatment? Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Mani, K. C. Kapil – PersonEntity: Name: NameFull: Acharya, Parimal IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 05 Text: May2018 Type: published Y: 2018 Identifiers: – Type: issn-print Value: 03412695 Numbering: – Type: volume Value: 42 – Type: issue Value: 5 Titles: – TitleFull: International Orthopaedics Type: main |
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