scholarly journals Computer navigated reduction of scaphoid non-unions and displaced scaphoid fractures- a cadaveric study

10.29007/h9w1 ◽  
2018 ◽  
Author(s):  
Michael Chu-Kay Mak ◽  
Elvis Chun-Sing Chui ◽  
Wing-Lim Tse ◽  
Pak-Cheong Ho
Keyword(s):  
Bone Defect ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Computer Navigation ◽  
Anatomical Reconstruction ◽  
Scaphoid Bone ◽  
Computer Assisted ◽  
Proximal Fragment ◽  
Non Union ◽  
K Wires

IntroductionScaphoid non-union results the typical humpback deformity, pronation of the distal fragment, and a bone defect in the non-union site with shortening. Bone grafting, whether open or arthroscopic, relies on fluoroscopic and direct visual assessment of reduction. However, because of the bone defect and irregular geometry, it is difficult to determine the precise width of the bone gap and restore the original bone length, and to correct interfragmentary rotation. Correction of alignment can be performed by computer-assisted planning and intraoperative guidance. The use of computer navigation in guiding reduction in scaphoid non-unions and displaced fractures have not been reported.ObjectiveWe propose a method of anatomical reconstruction in scaphoid non-union by computer-assisted preoperative planning combined with intraoperative computer navigation. This could be done in conjunction with a minimally invasive, arthroscopic bone grafting technique.MethodsA model consisting of a scaphoid bone with a simulated fracture, a forearm model, and an attached patient tracker was used. 2 titanium K-wires were inserted into the distal scaphoid fragment. 3D images were acquired and matched to those from a computed tomography (CT) scan. In an image processing software, the non-union was reduced and pin tracts were planned into the proximal fragment. The K-wires were driven into the proximal fragment under computer navigation. Reduction was assessed by direct measurement.These steps were repeated in a cadaveric upper limb. A scaphoid fracture was created and a patient tracker was inserted into the radial shaft. A post-fixation CT was obtained to assess reduction.Results and DiscussionIn both models, satisfactory alignment was obtained. There were minimal displacement and articular stepping, and scaphoid length was restored with less than 1mm discrepancy. This study demonstrated that an accurate reduction of the scaphoid in non-unions and displaced fractures can be accurately performed using computed navigation and computer-assisted planning. It is the first report on the use of computer navigation in correction of alignment in the wrist.

Scaphoid Non-Union: The Role of Vascularized Grafting In Recalcitrant Non-Unions of the Scaphoid

2006 ◽  
Vol 31 (2) ◽  
pp. 185-190 ◽  
Author(s):  
A. D. TAMBE ◽  
L. CUTLER ◽  
J. STILWELL ◽  
S. R. MURALI ◽  
I. A. TRAIL ◽  
...  
Keyword(s):  
Clinical Problem ◽  
Scaphoid Bone ◽  
Proximal Fragment ◽  
Postoperative Function ◽  
Non Union ◽  
Formidable Challenge ◽  
Skeletal Complications ◽  
K Wires

Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-union were treated with vascularized pedicle bone grafting and supplementary corticocancellous grafting. Five had screw fixation and six were fixed with K-wires. The average age of the patients was 28 years, average duration of the non-union was 39 months and mean radiological follow-up was 32 months. There were no significant skeletal complications, although two patients developed neuromata. At review, only six of the 11 non-unions were united. Whilst this is a difficult clinical problem and achieving union is a formidable challenge, we believe that there is a role for such extensive surgery in order to achieve good postoperative function.

Long-Term Results after Silicone Prosthesis Replacement of the Proximal Pole of the Scaphoid Bone in Advanced Scaphoid Nonunion

2002 ◽  
Vol 27 (5) ◽  
pp. 417-423 ◽  
Author(s):  
P. HAUSSMANN
Keyword(s):  
Scaphoid Fracture ◽  
Long Term Results ◽  
Partial Replacement ◽  
Scaphoid Bone ◽  
Proximal Fragment ◽  
Carpal Collapse ◽  
X Ray ◽  
Silicone Prosthesis ◽  
Prosthesis Replacement

The treatment of scaphoid fracture nonunion with a small proximal fragment with disturbed circulation and radioscaphoid arthrosis is difficult, and the result is often unsatisfactory. For this reason, in 1981 the replacement of the proximal fragment by a silicone lunate prosthesis was recommended for such cases. From 1980 to 1984, 11 patients (all male, average age 42 [range, 25–59] years) with the conditions described above were treated by silicone prosthesis partial replacement of the scaphoid. In one patient, the prosthesis had to be removed due to dislocation, and in another patient an arthrodesis of the wrist had to be carried out after 5 years due to increasing pain. All nine remaining patients were followed up after an average of 14 (range, 12–16) years, and were clinically and radiologically re-examined and assessed using the evaluation scheme proposed by Martini (1999) . The overall results were satisfactory. Specifically, the outcome was good in one case, satisfactory in six cases, and poor in two cases. Concerning the individual criteria, the best scores were observed in “subjective overall assessment” and in “work and sports”, whilst the worst were found in “movement” and “X-ray”. For all patients, X-ray examination revealed both postoperative arthrosis and extensive multiple cystoid osteolysis, presumably due to silicone synovitis. Nevertheless, most patients were free of symptoms. None of the patients felt that further treatment was necessary. Silicone prosthesis partial replacement of the scaphoid leads to long-term reduction in pain and adequate hand function. However, it is not capable of preventing carpal collapse and carpal arthrosis. Furthermore, since in several cases a progressive silicone synovitis developed, the method was rightly abandone d after 1984.

A 22-year-old chronic scaphoid non-union treated with arthroscopic percutaneous scaphoid fixation – A case report and review of literature

2020 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Syed Shumon ◽  
Moin Durrani ◽  
Karthikeyan P. Iyengar ◽  
William Y. C. Loh
Keyword(s):  
Conservative Treatment ◽  
Internal Fixation ◽  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Carpal Bone ◽  
Non Union ◽  
Scaphoid Fractures ◽  
First Case ◽  
Vascularized Bone ◽  
Little Finger

Scaphoid fractures are the most common fractures of the carpal bone. Most heal with adequate conservative treatment, but reports of non-union after conservative treatment have been up to 50%. Symptomatic non-union of a scaphoid fracture remains a common disabling problem. It is known that the scaphoid non-union will inevitably progress to the scaphoid non-union advance collapse over time. Surgical management of chronic non-union of scaphoid fracture includes vascularized bone grafting or non-vascularized bone grafting with or without internal fixation. A 36-year-old male presented with a hyperextension injury to the left little finger. An X-ray showed left little finger distal interphalangeal joint dislocation and an incidental 22-year-old chronic non-union scaphoid fracture. To date, incidental discovery of non-union is at the rate of 0.14%. The patient underwent arthroscopic non-vascularized bone grafting with internal fixation after the natural course of the condition was explained to him. He made a good recovery with a complete union of his scaphoid and resolution of his wrist pain. Our case describes the first case of arthroscopic repair of a chronic non-union scaphoid fracture of 22-year duration and demonstrates union of scaphoid fracture and resolution of symptoms can be achieved with good surgical fixation even extremely prolonged chronic non-union.

Factors influencing the outcome of bone grafting surgery for scaphoid fracture non-union

Injury ◽  
2000 ◽  
Vol 31 (8) ◽  
pp. 605-607 ◽  
Author(s):  
A.J.H Trezies ◽  
T.R.C Davis ◽  
N.J Barton
Keyword(s):  
Bone Grafting ◽  
Scaphoid Fracture ◽  
Non Union ◽  
Factors Influencing

scholarly journals Scaphocapitate fracture syndrome in a child

2021 ◽  
Vol 9 (4) ◽  
pp. 471-476
Author(s):  
Patrícia Wircker ◽  
Teresa Alves da Silva ◽  
Rafael Dias
Keyword(s):  
Avascular Necrosis ◽  
Open Reduction ◽  
Soft Tissues ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Radiographic Appearance ◽  
Manual Pressure ◽  
Both Bones ◽  
K Wires ◽  
Scaphocapitate Fracture Syndrome

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

Correction of Dorsi-Flexed Intercalated Segment Instability after Restoration of Scaphoid Height in a Cadaver Model of Scaphoid Non-Union

1995 ◽  
Vol 20 (5) ◽  
pp. 596-602 ◽  
Author(s):  
M. YASUDA ◽  
M. KUSUNOKI ◽  
K. KAZUKI ◽  
Y. YAMANO
Keyword(s):  
Mechanical Loading ◽  
Bone Defect ◽  
Carpal Instability ◽  
Rigid Fixation ◽  
Anatomical Reduction ◽  
Non Union ◽  
Herbert Screw ◽  
Palmar Approach ◽  
Wrist Joints

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

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