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Treatment of scaphoid nonunion: Pedicled Vascularized Bone Graft vs. Traditional Bone Graft

Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第5期33卷 713-716页

作者：鲍远康皓张滋洋聂铭博郭风劲 Department of Orthopedics Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.

关键词： scaphoid nonunion Herbert screw vascularized bone grafts

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Long-term outcomes of the four-corner fusion of the wrist:A systematic review

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World Journal of Orthopedics 2022年第1期13卷 112-121页

作者： Octavian Andronic Ladislav Nagy Marco D Burkhard Fabio A Casari Daniel Karczewski Philipp Kriechling Andreas Schweizer Lukas Jud Department of Orthopaedics Balgrist University HospitalUniversity of ZürichSwitzerlandZürich 8008Switzerland Department of Trauma and Orthopaedics CharitèUniversity Medicine BerlinCenter for Musculoskeletal SurgeryBerlin 10117Germany

BACKGROUND Four-corner fusion(4CF)is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse.Little is known about the long-term survivorship and outcomes of 4CF.AIM To report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODS The systematic review protocol was registered in the international prospective register of systematic reviews(PROSPERO)and followed the PRISMA guidelines.Original articles were screened using four different databases.Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included.Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTS A total of 11 studies including 436 wrists with a mean follow-up of 11±4 years(range:6-18 years)was included.Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69%±11%(range:50%-87%).Fusion rate could be extracted from 9/11 studies and averaged 91%.Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1±1(range:0-2)and across 9 studies with an average Disabilities of the Arm,Shoulder and Hand score of 21±8(range:8-37).At last follow-up,the cumulative conversion rate to total wrist fusion averaged 6%.There were no conversions to total wrist arthroplasty.CONCLUSION The 4CF of the wrist is a reliable surgical technique,capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.

关键词： Four-corner fusion Partial wrist arthrodesis Midcarpal arthrodesis Scapholunate collapse wrist scaphoid nonunion advanced collapse scaphoid nonunion

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Radiographic evaluation of vascularity in scaphoid nonunions:A review

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World Journal of Orthopedics 2020年第11期11卷 475-482页

作者： Hena S Cheema Adnan N Cheema Department of Diagnostic Radiology University of PennsylvaniaPhiladelphiaPA 19104United States Department of Orthopaedic Surgery University of PennsylvaniaPhiladelphiaPennsylvania 19104United States

scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.

关键词： Vascularity Perfusion scaphoid fracture scaphoid nonunion scaphoid open reduction and internal fixation Bone graft

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