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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Percutaneous Fixation without Bone Graft for Scaphoid Nonunion.

João Carlos Belloti1,2, Klebson Bruno Lopes Vasconcelos1, Jorge Raduan Neto1,2

  • 1Serviço de Cirurgia da Mão, Hospital Alvorada, United Health, São Paulo, SP, Brasil.

Revista Brasileira De Ortopedia
|December 28, 2020
PubMed
Summary

Percutaneous fixation without bone graft effectively treated scaphoid nonunion, achieving consolidation and good functional outcomes in all patients. This minimally invasive technique shows promise for scaphoid fracture treatment.

Keywords:
fractures, bonepseudarthrosisscaphoid bone

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Traumatology

Background:

  • Scaphoid nonunion is a common complication of scaphoid fractures.
  • Traditional treatments may involve bone grafting and have higher morbidity.
  • Percutaneous fixation without bone graft offers a potentially less invasive alternative.

Purpose of the Study:

  • To evaluate the clinical and radiographic outcomes of percutaneous fixation without bone graft for scaphoid nonunion.
  • To assess functional recovery and pain levels after the procedure.
  • To determine the efficacy of this technique with a minimum six-month follow-up.

Main Methods:

  • A case series of patients with scaphoid nonunion (waist or proximal pole) was prospectively evaluated.
  • Inclusion criteria included >6 months history, specific X-ray findings (Slade & Gleissler I-IV), and no MRI evidence of proximal pole necrosis.
  • Percutaneous fixation without bone graft was performed, followed by a minimum six-month follow-up.

Main Results:

  • All scaphoid nonunions achieved radiographic consolidation within six months.
  • Patients reported good functional outcomes, with low scores on the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires.
  • Minimal residual pain was reported (Visual Analog Scale [VAS]), with slight, statistically significant decreases in wrist range of motion compared to the contralateral side.

Conclusions:

  • Percutaneous fixation without bone graft is an effective treatment for scaphoid nonunion, leading to consolidation and favorable functional results.
  • This technique presents a promising option with potentially lower technical demand and morbidity.
  • Further comparative studies are needed to validate its effectiveness against other treatment modalities.