The computed tomography scans of both the injured and the normal wrists of nine patients with a scaphoid nonunion of 5 to 120 months' duration were used to create three-dimensional computer models. When the computer images of the normal and the contralateral fractured scaphoids were superimposed, it was possible to calculate the volume of bone that was lost as a result of the injury and its failure to heal, as well as the angular relationship of the fracture components to one another. The amount of the scaphoid bone that was lost varied from 6% to 15% of bone volume and did not show a linear correlation with the duration of the nonunion. The configuration of the missing bone was consistent and exhibited a prismatic shape whose base is quadrilateral and faces palmarly. The proximal scaphoid fracture component is extended, radially deviated, and supinated in relation to its distal fracture component. The consistent fracture deformity and the configuration of the bony defect in the scaphoid waist nonunions should be helpful in the understanding and treatment of the condition.
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Introduction: The goal of this work is to determine, using the analysis of our own patient group and current professional publications, in which cases fractures of the scaphoid waist can be treated conservatively by short-term plaster fixation with a low risk of non-union developing.
Material And Method: A group of 19 patients (17 men and 2 women) with the mean age 31 years (range 20-43, SD 7.3) with fractures of scaphoid waist were indicated for conservative treatment.
Article Synopsis
- The study investigates the effectiveness of two types of bone grafts (packed cancellous vs. corticocancellous) used in repairing scaphoid waist nonunion fractures with volar locking plates.
- Postoperative CT scans showed that 95% of patients achieved osseous bridging, but those with packed cancellous grafts had significantly better healing outcomes than those with corticocancellous grafts.
- The findings suggest that using packed cancellous autografts may lead to faster and more effective bone healing in these cases.
Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon's Practice and the Evidence.
J Hand Surg Glob Online
November 2024
University of Kansas Medical Center, Department of Plastic, Burn, and Wound Surgery, Kansas City, KS.
Purpose: The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership's practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management.
Methods: Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs.
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Cureus
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Orthopedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Introduction: Scaphoid fractures are one of the most common carpal bone fractures, with most fractures involving the waist. When surgery is indicated, internal fixation with screws is the standard method for the fixation of these fractures. Accurate length and trajectory of the screw are two crucial parameters essential for optimal internal fixation.
View Article and Find Full Text PDFArthroscopic Versus Open Bone Grafting and Internal Fixation of Scaphoid Nonunion-A Systematic Review.
Indian J Orthop
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Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Background: Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion.
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