Yıl: 2023 Cilt: 76 Sayı: 1 Sayfa Aralığı: 75 - 84 Metin Dili: İngilizce DOI: 10.4274/atfm.galenos.2023.35492 İndeks Tarihi: 17-07-2023

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

Öz:
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.
Anahtar Kelime:

Skafoid Kaynamama Tedavisi için Artroskopik Kemik Greftleme ve Perkütan K-Teli Tespitinin Erken Klinik Sonuçları

Öz:
Amaç: Bu çalışmada skafoid kaynamama cerrahisinde artroskopik otolog kemik grefti ve K-teli fiksasyonunu ameliyatı yapılan hastaların klinik sonuçlarını incelemek ve bu yöntemin başarısını etkileyen faktörlere dikkat çekmek amaçlanmaktadır. Gereç ve Yöntem: Tek merkezli retrospektif yapılan çalışmaya, ortalama yaşı 31 olan (aralık, 20-45 yaş) 9 hasta (7 erkek, 2 kadın) dahil edildi. Hastaları radyolojik olarak değerlendirmek için direkt skafoid seri grafileri ve bilgisayarlı tomografi kullanıldı. Fonksiyonel sonuçları değerlendirmede el bileği fonksiyonunu değerlendirmek için kol omuz ve el yetersizliği (DASH), Mayo bilek skoru (MWS), görsel analog skala (VAS) skorları kullanıldı. Hastaların ameliyat öncesi ve sonrası el bilek fleksiyon-ekstansiyon aralığı değerlendirildi. Ameliyat sonrası ameliyat olan el ile karşı etkilenmemiş elin kavrama kuvveti ölçüldü. Bulgular: Ortalama skafoid kemiğin kaynama süresi 8,5 haftadır. Dokuz hastanın 3’ünde kaynama izlenmemiştir. Hastaların VAS skoru 6,5’ten 1,7’ye düştü. El bilek hareket açıklığı 81 derecen 101 dereceye çıktı. Bu değer karşı tarafın %75’i kadardır. DASH skoru ve MWS ameliyat sonrası iyileşti. Son takiplerinde, elde kavrama kuvveti karşı tarafın %78’i kadardı. Sonuç: Skafoid kaynamama alanının debridmanı ile kırık uçlarında noktasal kanama gözlenmemesi ve K-teliyle yapılan tespitin ikinci bir ameliyatla 8 hafta sonunda erken çıkarılması başarısızlığın en önemli sebepleridir. Bu teknikte K-telleri yerine başsız vidaların kullanımı cerrahi başarısızlığı azaltabilir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 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 for Scaphoid Nonunions Effective? Clin Orthop Relat Res. 2016;474:204-212.
  • 13. Delgado-Serrano PJ, Jiménez-Jiménez I, Nikolaev M, et al. Arthroscopic reconstruction 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 the scaphoid. 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 scaphoid nonunion. 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 unstable scaphoid nonunions: effects on restoration of carpal alignment and recovery of wrist function. Arthroscopy. 2015;31:460-469
  • 26. Leyshon A, Ireland J, Trickey EL. The treatment of delayed union and nonunion of 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. J Hand Surg Am. 2008;33:988-997.
  • 29. Lamon B, Ardouin L, Bellemère P, et al. Arthroscopic Bone Grafting for Scaphoid Nonunion: A Retrospective Study of 42 Cases. J Hand Surg Asian Pac Vol. 2021;26:545-554
APA Bezirgan U, yoğun y, GEZER M, ARMANGİL M (2023). Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. , 75 - 84. 10.4274/atfm.galenos.2023.35492
Chicago Bezirgan Uğur,yoğun yener,GEZER Mehmet Can,ARMANGİL Mehmet Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. (2023): 75 - 84. 10.4274/atfm.galenos.2023.35492
MLA Bezirgan Uğur,yoğun yener,GEZER Mehmet Can,ARMANGİL Mehmet Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. , 2023, ss.75 - 84. 10.4274/atfm.galenos.2023.35492
AMA Bezirgan U,yoğun y,GEZER M,ARMANGİL M Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. . 2023; 75 - 84. 10.4274/atfm.galenos.2023.35492
Vancouver Bezirgan U,yoğun y,GEZER M,ARMANGİL M Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union. . 2023; 75 - 84. 10.4274/atfm.galenos.2023.35492
IEEE Bezirgan U,yoğun y,GEZER M,ARMANGİL M "Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union." , ss.75 - 84, 2023. 10.4274/atfm.galenos.2023.35492
ISNAD Bezirgan, Uğur vd. "Early Clinical Results of Arthroscopic Bone Grafting and Percutaneous K-Wire Fixation for the Treatment of Scaphoid Non-Union". (2023), 75-84. https://doi.org/10.4274/atfm.galenos.2023.35492
APA Bezirgan U, yoğun y, GEZER M, ARMANGİL 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 - 84. 10.4274/atfm.galenos.2023.35492
Chicago Bezirgan Uğur,yoğun yener,GEZER Mehmet Can,ARMANGİL 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, no.1 (2023): 75 - 84. 10.4274/atfm.galenos.2023.35492
MLA Bezirgan Uğur,yoğun yener,GEZER Mehmet Can,ARMANGİL 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, vol.76, no.1, 2023, ss.75 - 84. 10.4274/atfm.galenos.2023.35492
AMA Bezirgan U,yoğun y,GEZER M,ARMANGİL 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 - 84. 10.4274/atfm.galenos.2023.35492
Vancouver Bezirgan U,yoğun y,GEZER M,ARMANGİL 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 - 84. 10.4274/atfm.galenos.2023.35492
IEEE Bezirgan U,yoğun y,GEZER M,ARMANGİL 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, 76, ss.75 - 84, 2023. 10.4274/atfm.galenos.2023.35492
ISNAD Bezirgan, Uğur vd. "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 (2023), 75-84. https://doi.org/10.4274/atfm.galenos.2023.35492