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Abstract
Purpose
Bone graft is a widely accepted surgical treatment for scaphoid nonunion. The purpose of this study was to analyze and compare the clinical outcomes of the three different bone graft techniques, Matti-Russe technique, Fisk-Fernandez technique and vascularized bone grafting.
Materials and Methods
This study involved 20 cases in 20 patients of established scaphoid nonunion who were treated with three different bone graft techniques and followed up for at least 1 year. We measured preoperative and postoperative pain, Mayo Modified Wrist Score (MMWS) and range of motion of the affected and normal side. For radiological evaluation we assessed bone union, avascular necrosis, and dorsal intercalated segment instability (DISI).
Results
There were no significant differences among the three groups with respect to the pain, MMWS, and range of motion. The union rate and correction of DISI also made no significant difference. The time to achieve bone union, which averaged 2.6 months was significantly decreased in the vascularized bone graft group than in the other two groups.
Conclusion
All three methods were proper surgical procedures for treatment of scaphoid nonunion because there was no statistically significant difference in clinical and radiological outcomes. Among these three methods the vascularized bone grafting had the shortest time to achieve bone union so it could result in the fast functional recovery of the patient.
Figures and Tables
Figure 1
A 34-year-old man who was in duced to osteosynthesis using Matti-Russe technique. (A, B) Preoperative plain radiographs show scaphoid waist fracture and nonunion. (C, D) Preoperative CT images show cystic change of proximal fragment. (E, F) Preoerative MRI images. Avascular necrosis of proximal fragment appeared. (G, H) Immediately postoperative plain radiographs. (I, J) Solid bony union was achieved in follow-up plain radiographs.
Figure 2
A 48-year-old man who was induced to osteosynthesis using Fisk-Fernandez technique. (A, B) A preoperative plain radiographs show scaphoid waist fracture and nonunion. (C) Preoperative CT images. (D, E) Immediate postoperative images. The fragment was fixed by Acutrek screw. And to prevent rotational displacement, additional K-wire was inserted. (F, G) Solid bony union was achieved and alignment was well maintained.
Figure 3
A 33-year-old man who was induced to osteosynthesis using vascularized bone graft technique. (A, B) Preoperative plain radiographs. (C, D) Immediately postoperative plain radiograph. (E, F) Last follow up plain radiographs show solid bony union. (G, H) Preoperative T2 weight MRI show low signal changes in proximal pole of scaphoid. (I-K) He was satisfied with pain free wrist ROM but, ROM was slightly decreased in the operated wrist.
References
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