2 - Artur Costa Neto

Centro Hospitalar de Entre Douro e Vouga
ORTHOPAEDICS DEPARTMENT Director : António Miranda MD
Spine Unit
MD Bessa da Silva and Artur Teixeira
Knee Unit
MD Francisco Silva, Manuel Mendonça and
Nuno Tavares
Shoulder and Elbow Unit
MD António Miranda and Herculano Nascimento
Foot and Ankle Unit
MD António Torres, Carlos Burmester and Marta
Gomes
Hip Unit
MD Cruz de Melo, Daniel Silva, Hernani Reis and
Sílvio Dias
Hand and Wirst Unit
MD J.M. Teixeira e A. Neto
Scaphoid pseudoarthrosis surgical
treatment
Medicin Consultor
Dra. Natividade Duarte
VERA RESENDE1, JOSÉ MANUEL TEIXEIRA2, ARTUR
NETO2, FERNANDO LEAL1, RICARDO FRADA1,
ANTÓNIO MIRANDA2
Plastic Consultor
MD António Conde and Armindo Pinto
Neurosurgery Consultor
Prof. Manuel Laranjeira
Reumatology Consultor
Dra. Paula Valente
Residents
MD Vera Resende, Fernando Leal, Ricardo Frada
and João Teixeira
1 – Orthopaedics resident
2 – Orthopaedics graduate
Introduction
Due to the importance of scaphoid in wrist mechanics
Typically, the injury affects young active
males and results from a fall on the
outstretched hand.
Uncommon in children because the physis of distal radius fails first
Second to the distal radius in frequency
Missed diagnosis of an acute scaphoid
fracture exposes the patient to the risk of
nonunion and malunion and their
attendant sequelae, including scapholunate
advanced collapse of the wrist.
Introduction
IIIA
IIIB
Treatment options
•
•
•
•
•
•
1. Radial Stiloidectomy
2. Excision of the scaphoid
3. Proximal row carpectomy
4. Bone grafting
5. Vascularized bone graft
6. Arthodesis
Matti-Russe modified
Fernandez
(Fernandez DL : J Hand Surg9A:733, 1984.)
Vascularized bone graft
9
8
7
5%
6
5
4
MEN
95%
3
2
1
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Age - 26.16 y (14-53) 52% R ; 48% L
VI
1
2,3%
V
2
4,6%
Waist
IV
III
II
6
18
12
14%
41,8%
28%
Proximal pole
I
4
9,3%
Tuberosital
Distal
Body
83,8%
Results
Pain
46,9% 40,6%
Pain
absolut
%
0
5
15,625
1
2
6,25
2
8
25
3
9
28,125
4
2
6,25
5
2
6
12,5%
DASH
Mean
15,415
6,25
Standard
deviation
15,9295
0
0
Minimum
0
7
2
6,25
8
0
0
Maximum
65
9
2
6,25
Total
32
100
Results
Range of Motion
Mean Extension 55,9º (N 75º)
Mean Flexion 55,3º (N 80º)
Radial deviation 2,81º (N 15º-25º)
Ulnar deviation 21,25º (N 30º-45º)
Wirst and Grip strength
Hand operated
Other hand
41,5
10,3
50
11,2
Wrist
Grip
100
90
80
70
60
50
40
30
20
10
0
Flexão
Flexion
Extensão
Extension
Força de
Wrist
preensão
Força de pinça
Grip
Results
60
DOR
Pain
DASH
50
Linear (Pain)
(DOR)
40
Linear (DASH)
30
Força
WristPreensão
strength
Flexão
Flexion
Extensão
Extension
20
10
0
0
5
10
15
20
25
30
35
-10
1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940414243
Pearson Correlation (P=0,006): age is negatively correlated with mobility and power,
pain is positively correlated with DASH and negatively correlated with wrist and grip
strength
Nonunion  14%
Alnot
Nº
%
I
17
39,5
IIA
12
27,9
IIB
10
23,2
IIIA
2
4,7
IIIB
-
-
IV
2
4,7
OTHER COMPLICATIONS:
• Osteosynthesis intolerance (23%)  EMOS
• Schaphoid colapse (2,3%)
• Intracarpus artrosis (13,9%)
Left hand
Conclusions
• 86% consolidation rate
• Good results in 87,5% of the pacients
• Osteosynthesis is not good for Alnot IV (AVN)
• We can’t say we stop the Natural History of the
disease
• Recent studies indicated that virtually all unstable
nonunions lead to carpal collapse and posttraumatic
arthritis,, for this reason treatment is recommended
for all scaphoid nonunions even if asymptomatic
• Scaphoid Fractures, American Academy of Orthopaedic Surgeons, Bone and Joint
Decade, 2007, pp: 1-71
• The natural history of scaphoid non-union. A review of fifty-five cases, LK Ruby, J
Stinson and MR Belsky, J Bone Joint Surg Am. 1985;67:428-432
• Fracture of the Carpal Navicular: Diagnosis, Non-operative Treatment, and
Operative Treatment, Otto Russe J Bone Joint Surg Am. 1960;42:759-768
• Surgical Treatment of Nonunion and Avascular Necrosis of the Proximal Part of the
Scaphoid in Adolescents, Peter M. Waters and Susan L. Stewart J Bone Joint Surg Am.
2002;84:915-920
• Cal vicieux du scaphoïde Scaphoid malunion, P. Saffar, Chirurgie de la main 27
(2008) 65–75
• Treatment for scaphoid fracture and nonunion—the application of 3.0 mm cannulated
screws and pedicle vascularised bone grafts, Yuan-Kun Tu1, at all, Injury, Int. J. Care
Injured (2008) 39S4, S96–S106
• Rockwood and Green's Fractures in Adults. 5th ed. Volumes 1