Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union

Uğur Bezirgan; Yener Yoğun; Mehmet Can Gezer; Mehmet Armangil

doi:10.4274/atfm.galenos.2023.35492

Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union

Abstract

Objectives: The aim of this study was to examine the clinical results of patients treated with arthroscopic autologous bone grafting and K-wire fixation in surgery for scaphoid non-union, and the factors affecting the success of this method. Materials and Methods: This single-centre retrospective study included 9 patients (7 males, 2 females) with a mean age of 31 years (range, 20-45 years). Radiological evaluations of the patients were made from direct radiographs and computed tomography images. The disability of the arm shoulder and hand (DASH), Mayo wrist score (MWS), and visual analog scale (VAS) scores were used in the evaluation of functional results. The range of flexion -extension of the wrist was evaluated pre and postoperatively. Grip strength of the operated hand was measured postoperatively and was compared with the non-operated contralateral hand. Results: The mean time to union of the scaphoid bone was 8.5 weeks. Non-union was observed in 3 patients. The VAS score of the patients decreased from 6.5 preoperatvely to 1.7 postoperatively, and the wrist range of movement increased from 81° to 101°. These values were determined to be 75% of those of the non-operated side. The DASH score and MWS improved postoperatively. Conclusion: The main reasons for failure are not observing bleeding points in the fracture ends with debridement of the non-union area and early removal at the end of 8 weeks of the fixation made with K-wires in a second operation. The use of headless screws instead of K-wires in this technique can reduce the rates of surgical failure.

Keywords

Ethical Statement

Ethics Committee Approval: The study was approved by Ankara University Faculty of Medicine, Human Research Ethics Committee (date: 19.12.2022, approval no: İ11-675-22). Informed Consent: Single-center retrospective study. Peer-reviewed: Externally peer-reviewed.

References

1. Geissler WB, Adams JE, Bindra RR, et al. Scaphoid fractures: what’s hot, what’s not. Instr Course Lect. 2012;61:71-84.
2. Gaspar MP, Kane PM, Jacoby SM, et al. Novel Treatment of a Scapholunate Ligament Injury with Proximal Pole Scaphoid Nonunion. J Hand Microsurg. 2016;8:52-56.
3. Ghoneim A. The unstable nonunited scaphoid waist fracture: results of treatment by open reduction, anterior wedge grafting, and internal fixation by volar buttress plate. J Hand Surg Am. 2011;36:17-24.
4. Slade JF 3rd, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg. 2008;97:280-289.
5. Lee YK, Choi KW, Woo SH, et al. The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions. Medicine (Baltimore). 2018;97:e9987.
6. Slade JF 3rd, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res. 2006;445:108-119.
7. Rhee PC, Jones DB Jr, Shin AY, et al. Evaluation and Treatment of Scaphoid Nonunions: A Critical Analysis Review. JBJS Rev. 2014;2:e4.
8. Smith ML, Bain GI, Chabrel N, et al. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion. J Hand Surg Am. 2009;34:1037-1043.

9. Chaudhry T, Uppal L, Power D, et al. Scaphoid Nonunion With Poor Prognostic Factors: The Role of the Free Medial Femoral Condyle Vascularized Bone Graft. Hand (N Y). 2017;12:135-139.
10. Wong WC, Ho PC. Arthroscopic Management of Scaphoid Nonunion. Hand Clin. 2019;35:295-313.
11. Ecker J. Scaphoid Union: The Role of Wrist Arthroscopy. Hand Clin. 2017;33:677-686.
12. Kang HJ, Chun YM, Koh IH, et al. Is Arthroscopic Bone Graft and Fixation forScaphoid Nonunions Effective? Clin Orthop Relat Res. 2016;474:204-212.
13. Delgado-Serrano PJ, Jiménez-Jiménez I, Nikolaev M, et al. Arthroscopicreconstruction for unstable scaphoid non-union. Rev Esp Cir Ortop Traumatol. 2017;61:216-223.
14. Waitayawinyu T, Lertcheewanan W, Boonyasirikool C, et al. Arthroscopic Treatment of Scaphoid Nonunion With Olecranon Bone Graft and Screw Fixation Leads to Union and Improved Outcomes. Arthroscopy. 2022;38:761-772
15. Haugstvedt JR, Wong CW. Arthroscopic treatment for nonunion of thescaphoid. Handchir Mikrochir Plast Chir. 2020;52:413-418
16. Wu F, Zhang Y, Liu B. Arthroscopic bone graft and fixation for proximal scaphoid nonunions. Bone Joint J. 2022;104-B:946-952.
17. Wang JP, Huang HK, Shih JT. Arthroscopic-assisted reduction, bone grafting and screw fixation across the scapholunate joint for proximal pole scaphoidnonunion. BMC Musculoskelet Disord. 2020;21:834.
18. Inoue G, Shionoya K, Kuwahata Y. Ununited proximal pole scaphoid fractures. Treatment with a Herbert screw in 16 cases followed for 0.5-8 years. Acta Orthop Scand. 1997;68:124-127.
19. Löw S, Kiesel S, Spies CK, et al. Arthroskopische Rekonstruktion des Skaphoids bei Pseudarthrose [Arthroscopic reconstruction of scaphoid nonunions]. Oper Orthop Traumatol. 2022;34:261-274.
20. Larson AN, Bishop AT, Shin AY. Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis. Tech Hand Up Extrem Surg. 2007 Dec;11:246-258.
21. Slade JF 3rd, Jaskwhich D. Percutaneous fixation of scaphoid fractures. Hand Clin. 2001;17:553-574.
22. Lee YK, Kim KB. Arthroscopic-assisted bone grafting and percutaneous K-wires fixation for the treatment of scaphoid nonunion in the skeletally immature patient:Three cases report. Medicine (Baltimore). 2021;100:e24095.
23. Hegazy G, Alshal E, Abdelaal M, et al. Kirschner wire versus Herbert screw fixation for the treatment of unstable scaphoid waist fracture nonunion using corticocancellous iliac bone graft: randomized clinical trial. Int Orthop. 2020;44:2385-2393.
24. Carter FM 2nd, Zimmerman MC, DiPaola DM, et al. Biomechanical comparison of fixation devices in experimental scaphoid osteotomies. J Hand Surg Am. 1991;16:907-912
25. Kim JP, Seo JB, Yoo JY, et al. Arthroscopic management of chronic unstablescaphoid nonunions: effects on restoration of carpal alignment andrecovery of wrist function. Arthroscopy. 2015;31:460-469
26. Leyshon A, Ireland J, Trickey EL. The treatment of delayed union and nonunionof the carpal scaphoid by screw fixation. J Bone Joint Surg Br.1984;66:124-127.
27. Wong WY, Ho PC. Minimal invasive management of scaphoid fractures:from fresh to nonunion. Hand Clin. 2011;27:291-307.
28. Kawamura K, Chung KC. Treatment of scaphoid fractures and nonunions. JHand Surg Am. 2008;33:988-997.
29. Lamon B, Ardouin L, Bellemère P, et al. Arthroscopic Bone Grafting forScaphoid Nonunion: A Retrospective Study of 42 Cases. J Hand Surg AsianPac Vol. 2021;26:545-554

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Uğur Bezirgan
0000-0001-9053-8637
Türkiye

Yener Yoğun
0000-0002-3070-5509
Türkiye

Mehmet Can Gezer ^*
0000-0001-7034-2522
Türkiye

Mehmet Armangil
0000-0003-0433-0253
Türkiye

Publication Date

May 25, 2023

Submission Date

January 4, 2023

Acceptance Date

March 2, 2023

Published in Issue

Year 2023 Volume: 76 Number: 1

DOI

https://doi.org/10.4274/atfm.galenos.2023.35492

IZ

https://izlik.org/JA26WF86KC

Cite

RIS / Bibtex

APA

Bezirgan, U., Yoğun, Y., Gezer, M. C., & Armangil, M. (2023). Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 76(1), 75-83. https://doi.org/10.4274/atfm.galenos.2023.35492

AMA

1.Bezirgan U, Yoğun Y, Gezer MC, Armangil M. Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76(1):75-83. doi:10.4274/atfm.galenos.2023.35492

Chicago

Bezirgan, Uğur, Yener Yoğun, Mehmet Can Gezer, and Mehmet Armangil. 2023. “Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76 (1): 75-83. https://doi.org/10.4274/atfm.galenos.2023.35492.

EndNote

Bezirgan U, Yoğun Y, Gezer MC, Armangil M (May 1, 2023) Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76 1 75–83.

IEEE

[1]U. Bezirgan, Y. Yoğun, M. C. Gezer, and M. Armangil, “Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 76, no. 1, pp. 75–83, May 2023, doi: 10.4274/atfm.galenos.2023.35492.

ISNAD

Bezirgan, Uğur - Yoğun, Yener - Gezer, Mehmet Can - Armangil, Mehmet. “Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 76/1 (May 1, 2023): 75-83. https://doi.org/10.4274/atfm.galenos.2023.35492.

JAMA

1.Bezirgan U, Yoğun Y, Gezer MC, Armangil M. Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;76:75–83.

MLA

Bezirgan, Uğur, et al. “Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 76, no. 1, May 2023, pp. 75-83, doi:10.4274/atfm.galenos.2023.35492.

Vancouver

1.Uğur Bezirgan, Yener Yoğun, Mehmet Can Gezer, Mehmet Armangil. Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023 May 1;76(1):75-83. doi:10.4274/atfm.galenos.2023.35492

Cited By

Arthroscopic Versus Open Bone Grafting and Internal Fixation of Scaphoid Nonunion—A Systematic Review

Indian Journal of Orthopaedics

https://doi.org/10.1007/s43465-024-01233-0