The management of proximal pole scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone graft and radial styloidectomy: A midterm outcome study
Journal Title: International Journal of Orthopaedics Sciences - Year 2018, Vol 4, Issue 4
Abstract
Background: The management of proximal pole nonunions of scaphoid with avascular necrosis remains the most controversial of all scaphoid fracture nonunions. Various types of vascularised bone grafts have been used to hasten union. We studied the union rate, clinical and functional outcome of 1, 2 intercompartmental supraretinacular arterial bone graft (1, 2 ICSRA) and radial styloidectomy for proximal pole scaphoid nonunion with avascular necrosis. Methods: We retrospectively analysed the four year outcome of vascularised distal radius bone graft (1, 2 ICSRA) and radial styloidectomy in 20 patients treated at our institution for proximal pole scaphoid nonunion with avascular necrosis between 2010 and 2014. Majority of cases (10) presented as failure of adequate immobilization. The average time to surgery from trauma was 14 months and mean duration of follow up was 30 months. Twelve (12) cases had features of early radioscaphoid arthritis. Nonunion and avascular necrosis were confirmed in all cases with radiographs and MRI scan. We followed the technique described by Zaidemberg et al for harvesting the vascualrised bone grafting from the distal radius. Results: Majority of the cases (80%) united by 20 weeks. There was significant improvement in the grip strength and pain postoperatively. Wrist flexion-extension and radial-ulnar deviation arcs improved but was not statistically significant. The Mayo Wrist Score showed 75 percent of patients had an excellent or good outcome. The scapholunate angle also improved from 62.5 deg to 46.5 deg postoperatively. Radiographic union was achieved in sixteen cases (80%) by 20 weeks. Three cases (15%) went for delayed union and achieved bony healing by thirty weeks. One case (5%) developed pintract infecton and progressed to radioscaphoid arthritis. Conclusions: Our study highlights the efficacy of 1,2 ICSRA vascualrised distal radius bone grafting in proximal pole scaphoid nonunions with avascualr necrosis in achieving good union rate with acceptable clinical and functional outcome in this difficult problem. This procedure can be done under regional block without the need for microsurgical set up and costly implants. Vascularised distal radius grafts with radial styloidectiomy is a promising solution for scaphoid proximal nonunions with avascular and early radioscaphoid arthritic changes.
Authors and Affiliations
Dr. Sibin Surendran, Dr. Raju Karuppal, Dr. Harsha T Valoor
Keywords
Related Articles
- EP ID EP487758
- DOI 10.22271/ortho.2018.v4.i4c.24
- Views 93
- Downloads 0
Treatment of ganglion by “needling”: By transfixation suture, an effective and cosmetic way
Ganglion is commonly encountered problem across all age groups. It is one of the most common soft tissue tumors. Most commonly, patients seek treatment for cosmetic reason. Though there are variety of treatment options a...
C2 dens fracture with closed cervical migration of a 6cm humeral fragment
Case: A 39-year-old woman, with bipolar disorder, suffered an eight-meter fall, resulting in dens and proximal and distal humeral fractures associated with migration of a 6cm humerus fragment to the left cervical region....
Study of early outcome of Austin Moore’s prosthesis with bone cement in fracture neck femur in elderly
Background: Femoral neck fractures, one of the most common injuries in the elderly and its prevalence has increased with improvement in life expectancy, increased incidence of osteoporosis, and changes in lifestyle leadi...
Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail
Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by...
Comparative study for efficacy of autologous growth factor rich plasma (GFRP) versus combination of low molecular weight hyaluronic acid and autologous growth factor rich plasma (GFRP) in bilateral osteoarthritis knee (Grade 1, Grade 2 according to kellgren-lawrence grading system)
Osteoarthritis knee in initial stages can be managed conservatively by various methods, here we did comparative study between intraarticular GFRP injection vs combination of low molecular weight hyaluronic acid & GFRP in...