Subscribe to RSS
DOI: 10.1055/s-0040-1712492
Percutaneous Fixation without Bone Graft for Scaphoid Nonunion[*]
Article in several languages: português | English
Abstract
Objective To describe the clinical and radiographic outcomes of patients submitted to percutaneous fixation without bone graft for scaphoid nonunion, with a minimum follow-up of six months.
Methods A case series study of a convenience sample of hand surgeons with prospective evaluation. Patients with scaphoid (waist or proximal pole) nonunion and the following features were included: more than six months of history; X-rays showing sclerosis of the edges of the nonunion, with resorption of the nonunion focus measuring less than 4 mm (Slade & Gleissler I, II, III and IV) and no angular deformity; and no proximal pole necrosis on magnetic resonance imaging (MRI).
Results After six months of follow-up, all nonunion were consolidated, with no major complications. The functional outcomes revealed good scores on the disabilities of the arm, shoulder and hand (DASH; n = 12; mean: 6.9; standard deviation [SD]: 2.1) and patient-rated wrist evaluation (PRWE; n = 12; mean: 7.97, SD: 1.5) questionnaires. The results of the visual analog scale (VAS) showed little residual pain (n = 12; mean: 0.71; SD: 0.2). Slight decreases in flexion (69 versus 59.1; p = 0.007), extension (62.4 versus 48.7; p = 0.001) and radial deviation (29.6 versus 24.6; p = 0.014) were detected in comparison to the contralateral side.
Conclusions All cases in the series presented consolidation and good functional scores at the six-month evaluation. This is a promising option (with lower technical demand and morbidity) for the treatment of scaphoid nonunion. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.
* Study developed at the Hand Surgery Service, Hospital Alvorada, United Health, São Paulo, SP, Brazil.
Publication History
Received: 20 September 2019
Accepted: 02 March 2020
Article published online:
24 September 2020
© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Lee SK. Fractures of the carpal bones. In: Green D, Hotchkiss R, Pederson W, Wolfe S. editors. Green's operative hand surgery. 7th ed. Philadelphia: Churchill Livingstone; 2016
- 2 Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of Scaphoid Nonunion: A Systematic Review of the Existing Evidence. J Hand Surg Am 2015; 40 (09) 1797-1805.e3
- 3 Quadlbauer S, Pezzei C, Beer T. et al. Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg 2019; 139 (02) 281-293
- 4 Kim JK, Kim JO, Lee SY. Volar percutaneous screw fixation for scaphoid waist delayed union. Clin Orthop Relat Res 2010; 468 (04) 1066-1071
- 5 Capo JT, Shamian B, Rizzo M. Percutaneous screw fixation without bone grafting of scaphoid non-union. Isr Med Assoc J 2012; 14 (12) 729-732
- 6 Haddad FS, Goddard NJ. Acute percutaneous scaphoid fixation. A pilot study. J Bone Joint Surg Br 1998; 80 (01) 95-99
- 7 Slade III JF, Jaskwhich D. Percutaneous fixation of scaphoid fractures. Hand Clin 2001; 17 (04) 553-574
- 8 Geissler WB. Arthroscopic management of scaphoid fractures in athletes. Hand Clin 2009; 25 (03) 359-369
- 9 Orfale AG, Araújo PM, Ferraz MB, Natour J. Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire. Braz J Med Biol Res 2005; 38 (02) 293-302
- 10 Goldhahn J, Shisha T, Macdermid JC, Goldhahn S. Multilingual cross-cultural adaptation of the patient-rated wrist evaluation (PRWE) into Czech, French, Hungarian, Italian, Portuguese (Brazil), Russian and Ukrainian. Arch Orthop Trauma Surg 2013; 133 (05) 589-593
- 11 Paranaíba VF, Santos JBGD, Raduan Neto J, Moraes VY, Belotti JC, Faloppa F. PRWE application in distal radius fracture: comparison and correlation with established outcomes. Rev Bras Ortop 2017; 52 (03) 278-283
- 12 Revill SI, Robinson JO, Rosen M, Hogg MI. The reliability of a linear analogue for evaluating pain. Anaesthesia 1976; 31 (09) 1191-1198
- 13 Barton NJ. Experience with scaphoid grafting. J Hand Surg Br 1997; 22 (02) 153-160
- 14 Schuind F, Haentjens P, Van Innis F, Vander Maren C, Garcia-Elias M, Sennwald G. Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg Am 1999; 24 (04) 761-776
- 15 Hegazy G. Percutaneous Screw Fixation of Scaphoid Waist Fracture Non-Union Without Bone Grafting. J Hand Microsurg 2015; 7 (02) 250-255
- 16 Vanhees M, van Riet RRP, van Haver A, Kebrle R, Meermans G, Verstreken F. Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist. J Wrist Surg 2017; 6 (03) 183-187
- 17 Geoghegan JM, Woodruff MJ, Bhatia R. et al. Undisplaced scaphoid waist fractures: is 4 weeks' immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?. J Hand Surg Eur Vol 2009; 34 (05) 631-637
- 18 de Moraes VY, Ferrari PM, Gracitelli GC, Faloppa F, Belloti JC. Outcomes in orthopedics and traumatology: translating research into practice. Acta Ortop Bras 2014; 22 (06) 330-333
- 19 Slade 3rd JF, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg 2008; 97 (04) 280-289