Arthroscopically Assisted Treatment by Percutaneous Internal Fixation and Injectable Bone Graft Substitutes for Management of Carpal Scaphoid Nonunion. Report of 18 Cases
JUVENSPAN M | DAHAN E
Seance of wednesday 13 march 2019 (Séance interventionnelle : traitement percutané des lésions de la main et du poignet)
DOI number : 10.26299/3gn2-hj19/emem.2018.4.004
Abstract
The purpose of this study was to evaluate the clinical outcome of patients who had arthrocopically assisted percutaneous internal fixation augmented by injection of a bone graft substitute for scaphoid nonunion.
From January 2016 through June 2018, a consecutive series of 18 male patients, mean age 25 years (20-30 years) who had a fibrous nonunion of the carpal scaphoid (9 dominant limbs), Schernberg type II : 7 cases, Type III: 11 cases, and were treated surgically after a delay of 6 to 37 months (mean 12 months) from the trauma. The surgical cure consists of the percutaneous internal fixation (pin for 5 cases and screws for 13 cases) supplemented with a bone graft harvesting from the radial metaphysis by a biopsy canula and injected by trocar under visual control. Duration of immobilization of 12 weeks followed by 13 sessions of physiotherapy on average (from 5 to 25 sessions). The pre- and postoperative assessment was clinical (mobility, gripp), Modified Mayo Wrist Score and radiographic over an average duration of 13.3 months (12-18 months).
The healing was obtained in all patients 12 weeks after surgery, both clinically and radiographically. After 6 months from surgery, the gripp increased from 26.21 to 38.14 Kg., The Modified Mayo Wrist Score at 6 months showed as results: 7 excellent; 10 good; 1 satisfactory. No postoperative complications were noted.
The treatment for scaphoid nonunion varies remain multiple. However, certain principles remain as: the preservation of scaphoid vascularization, nonunion debridement; the setting up of a stable osteosynthesis; and if it is necessary bone graft; a harvesting site with poor adverse effect. The surgical technique present here meets all the criteria previously described. The results are convincing with a moderate recovery time.
The treatment of scaphoid nonunion by arthroscopically assisted percutaneous internal osteosynthesis supplemented with bone graft is a reliable and reproducible method. It allows minimally invasive and under visual control to perform a stable osteosynthesis with bone graft resulting in a very satisfactory 6 months results.
From January 2016 through June 2018, a consecutive series of 18 male patients, mean age 25 years (20-30 years) who had a fibrous nonunion of the carpal scaphoid (9 dominant limbs), Schernberg type II : 7 cases, Type III: 11 cases, and were treated surgically after a delay of 6 to 37 months (mean 12 months) from the trauma. The surgical cure consists of the percutaneous internal fixation (pin for 5 cases and screws for 13 cases) supplemented with a bone graft harvesting from the radial metaphysis by a biopsy canula and injected by trocar under visual control. Duration of immobilization of 12 weeks followed by 13 sessions of physiotherapy on average (from 5 to 25 sessions). The pre- and postoperative assessment was clinical (mobility, gripp), Modified Mayo Wrist Score and radiographic over an average duration of 13.3 months (12-18 months).
The healing was obtained in all patients 12 weeks after surgery, both clinically and radiographically. After 6 months from surgery, the gripp increased from 26.21 to 38.14 Kg., The Modified Mayo Wrist Score at 6 months showed as results: 7 excellent; 10 good; 1 satisfactory. No postoperative complications were noted.
The treatment for scaphoid nonunion varies remain multiple. However, certain principles remain as: the preservation of scaphoid vascularization, nonunion debridement; the setting up of a stable osteosynthesis; and if it is necessary bone graft; a harvesting site with poor adverse effect. The surgical technique present here meets all the criteria previously described. The results are convincing with a moderate recovery time.
The treatment of scaphoid nonunion by arthroscopically assisted percutaneous internal osteosynthesis supplemented with bone graft is a reliable and reproducible method. It allows minimally invasive and under visual control to perform a stable osteosynthesis with bone graft resulting in a very satisfactory 6 months results.