Treatment of Scaphoid Waist Non-Union with A ModifiedMatti-Russe Technique: Our Experience Giuseppe
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
Background: Amongst the different techniques for scaphoid non-union, the Matti-Russe procedure is a simple method where a corticocancellous bone graft from the iliac crest is packed in the scaphoid. A variant of the technique used in our Department involves a longer incision and bone graft from the radius. Aim of the study was to evaluate the outcome of our variant of the Matti-Russe procedure for scaphoid nonunion. Materials and Methods: During a 30-year period (January 1986-June 2016), 29 patients referred to our Hospital with a scaphoid nonunion and underwent our modified Matti-Russe procedure. We sampled 16 patients (14M; 2F) with complete data who referred consecutively between January 2000 and June 2016 (age range: 15.6-59.8 years; average 34 years). Scaphoid non-union was classified according to Alnot. Post-operatively the wrist and thumb were immobilized in a cast for 6 weeks. Patients’ outcomes were assessed at 4-months and at 12-months post-op using the Mayo wrist score (MWS) questionnaire. Average follow-up was 18.4 ± 5.6 months. Results: Of 16 patients, 14 (87.5%) had good clinical and radiological outcome with union after 4.9 months. The MWS scores at 4-month and 12-month follow-up were respectively: excellent in 4 (25%) and 8 (50%) patients; good in 9 (56.3%) and 6 (37.5%) patients; satisfactory in 3 (18.8%) and 2 (12.5%) patients. Conclusion: Our variant the Matti-Russe procedure is a valid procedure, with a high union rate and has a further advantage of being less invasive. Our post-operative shorter time of immobilization leads to an improved range of motion and excellent and good MWS scores.Scaphoid fractures are a common type of fracture, accounting for up to 70% of carpal fractures [1,2], which occur frequently after a fall on the outstretched hand (hyperextension of the wrist joint). Usually patients present pain, with tenderness in the snuffbox, and limitation of movement especially in extension and radial deviation. A delayed diagnosis and subsequent delayed treatment may lead to avascular necrosis and non-union (up to 10% of fractures), mostly when there is involvement of the waist or the proximal pole of the scaphoid, due to its compromised vascularization [3,4]. A wide range of methods have been described for the treatment of these fractures, which comprise non-surgical (electostimulation) [5] and surgical techniques (open reduction, internal fixation with a screw and bone grafting) or a combination of both [6-10]. The aim of the surgical treatment is to correct the deformity, in order to avoid the carpal collapse and radiocarpal osteoarthritis. The rate of success of surgical fixations for scaphoid non-union is around 70% up to 90% [11,12]. When conventional non-vascularized bone grafting fails, due to a complete necrotic proximal pole, vascularized grafts may be used, which possess angiogenic and osteogenic factors [13- 15]. Amongst the different techniques, the Matti-Russe procedure is a simple method, described by Hermann Matti in 1937 [16,17] and later modified by Otto Russe in 1960 [18].
Authors and Affiliations
Andreoletti A, Désirée Moharamzadeh, Davide Molisani, Giorgio Piarulli, Costante Emanuel Grismondi
Keywords
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- EP ID EP571818
- DOI 10.26717/BJSTR.2017.01.000292
- Views 160
- Downloads 0
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