Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy
Autor: | S. Quadlbauer, C Schlintner, M. Leixnering, T. Beer, W Schaden, T. Keuchel, Ch. Pezzei, T Hausner, J Jurkowitsch |
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Rok vydání: | 2018 |
Předmět: |
Adult
Extracorporeal Shockwave Therapy Male medicine.medical_specialty medicine.medical_treatment Bone Screws Nonunion Wrist Iliac crest Ilium Fracture Fixation Internal 03 medical and health sciences Grip strength 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Range of Motion Articular Pain Measurement Retrospective Studies Scaphoid Bone 030222 orthopedics Bone Transplantation business.industry 030229 sport sciences General Medicine medicine.disease Surgery Pseudarthrosis Outcome and Process Assessment Health Care medicine.anatomical_structure Fractures Ununited Extracorporeal shockwave therapy Orthopedic surgery Female Tomography X-Ray Computed Range of motion business Bone Plates Follow-Up Studies |
Zdroj: | Archives of Orthopaedic and Trauma Surgery. 139:281-293 |
ISSN: | 1434-3916 0936-8051 |
Popis: | Scaphoid nonunion remains challenging for hand surgeons. Several treatment options are available such as: non-vascularized or vascularized bone grafting, with or without additional stabilization. In the last few decades, extracorporeal shockwave therapy (ESWT) has become an established procedure for treating delayed and nonunions. Purpose of this retrospective follow-up study was (a) to investigate union rate and clinical outcome of the different implants [either one/two headless compression screws (HCS) or a plate] and (b) union rate and clinical outcome using only surgery, or a combination of surgery and ESWT. The study included 42 patients with scaphoid nonunions of the waist with a mean follow-up of 52 months. All patients received a non-vascularized bone graft from the iliac crest and stabilization was achieved by using one, two HCS or a plate. ESWT was performed with 3000 impulses, energy flux density per pulse 0.41 mJ/mm2 within 2 weeks after surgery. Clinical assessment included range of motion (ROM), pain according to the Visual Analog Scale (VAS), grip strength, Disability of the Arm Shoulder and Hand Score, Patient-Rated Wrist Evaluation Score, Michigan Hand Outcomes Questionnaire and modified Green O’Brien (Mayo) Wrist Score. In addition, each patient had a CT scan of the wrist. A total of 33/42 (79%) patients showed union at the follow-up investigation. Patients treated with additional ESWT showed bony healing in 21/26 (81%) and without ESWT in 12/16 (75%). Patients that were stabilized using one HCS showed bony healing in 6/10 (60%), with two HCS 10/12 (83%) and by plate 17/20 (85%). The ESWT group had a significantly lower pain score according to the VAS and better modified Green O’Brien (Mayo) Score. No differences could be found in respect of ROM, grip strength, functional outcome score depending of which stabilization method was used. Stabilization of scaphoid waist nonunions with two HCS or plate showed higher union rates than a stabilization using only one HCS. In addition, ESWT combined with a nonvascularized bone graft from the iliac crest seems a suitable option for treating scaphoid nonunions. |
Databáze: | OpenAIRE |
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