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Results of Scaphoid Nonunion Treatment with Vascularised Bone Grafting from the Distal Radius

100%
Żyluk A., Walaszek I.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
26-34
EN
Misdiagnosis or failed treatment of scaphoid fractures are frequently (25-45%) followed by disrupted healing and nonunion. This may reduce the wrist's capacity for occupational and daily use and, over time, lead to wrist arthrosis. Therefore, surgery is recommended even in asymptomatic nonunions of the scaphoid; the goal of this treatment is to achieve bone union and stability of the wrist.The aim of the study was to evaluate the results of operative management of scaphoid nonunion by vascularized bone grafting from the distal radius.Material and methods. Eleven patients, nine men and two women of a mean age of 29 (range 19-45 years) with scaphoid nonunion lasting a mean of 10 months (range 8-20) were recruited. The nonunion was localized in the waist of the scaphoid in seven patients and in proximal 1/3 in four patients. Operations were performed using cancellous bone grafts taken from the distal radius and supplied by the intercompartmental branch of the radial artery. Fracture fixation was accomplished with K-wires or headless canullated screws. The follow-up assessment at a mean of 10 months included measurements of wrist range of motion, grip strength and Mayo wrist score.Results. All patients achieved bone union. The mean Mayo wrist score increased from 25 points preoperatively to 75 points at the final assessment, which suggested significant improvement of the hand functions. In a qualitative evaluation, two patients had an excellent result, four had a good result, four had a fair result and one had a poor result. Surgery resulted in significant pain relief and increase in hand strength, but failed to improve wrist range of motion. The modest clinical outcomes do not allow a definitive conclusion to be reached, but the fact that bone union was achieved in all patients with no complications justifies continued use of this technique for the management of scaphoid nonunion.
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Modern methods of treatment of post-traumatic bone defects in Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin

80%
Nogalski A., Jojczuk M., Lübek T., Kucmin T., Grabowski M.
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issue 1
42-44
EN
Motor organ injuries are one of the most common consequences of trauma, out of which comminuted fractures with a bone loss are the most challenging. Numerous methods are applied to treat these injuries; however, still in many cases we are unable to suggest successful medical treatment. Therefore, treating these injuries using elastic and surgically handleable bone replacement materials was started at Trauma Surgery and Emergency Medicine of Medical University of Lublin (provided for the experiments by Medical Inventi Lt). Preliminary assessment based on the results of treatment with bone replacement materials of two patients with comminuted fractures of femur was promising. Bone union was achieved without any adverse effects.
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