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Ilizarov fixation for the treatment of scaphoid nonunion: a novel approach

By: Publication details: 2017Uniform titles:
  • European Journal of Orthopaedic Surgery & Traumatology
Online resources: Summary: <h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">OBJECTIVES:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">To evaluate the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">DESIGN:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">This is a prospective study of 20 consecutive patients in one center.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">PATIENTS AND METHODS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">This study included 20 patients (19 males) with a mean SNU duration of 14.5&nbsp;months. Four patients had proximal pole, 15 had waist, and 1 had a distal SNU. Patients with carpal instability, humpback deformities, carpal collapse, avascular necrosis, and marked degenerative change were excluded. Following frame application, the treatment comprises three stages: The frame is distracted by 1&nbsp;mm per day until the radiographs show a 2-3&nbsp;mm opening at the SNU site (mean 10&nbsp;days); the SNU site is compressed for 5&nbsp;days, at a rate of 1&nbsp;mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the wrist is then immobilized in the Ilizarov fixator for 8&nbsp;weeks.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">RESULTS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">Radiographic (radiography and CT scan) and clinical bony union was achieved in all 20 patients after a mean of 90.3&nbsp;days (70-130&nbsp;days). All patients returned to their pre-injury occupations. Thirteen patients had excellent results, four good, and three fair, according to the Mayo wrist score.</span></p><h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">CONCLUSIONS:</span></h4><p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"><span style="font-size: 10pt;">In these selected patients, this technique safely achieved bony union without the need to open the SNU site and without the requirement of bone graft.</span></p>
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NMUH Staff Publications

27

&lt;h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;OBJECTIVES:&lt;/span&gt;&lt;/h4&gt;&lt;p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;To evaluate the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU), without the use of bone graft.&lt;/span&gt;&lt;/p&gt;&lt;h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;DESIGN:&lt;/span&gt;&lt;/h4&gt;&lt;p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;This is a prospective study of 20 consecutive patients in one center.&lt;/span&gt;&lt;/p&gt;&lt;h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;PATIENTS AND METHODS:&lt;/span&gt;&lt;/h4&gt;&lt;p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;This study included 20 patients (19 males) with a mean SNU duration of 14.5&amp;nbsp;months. Four patients had proximal pole, 15 had waist, and 1 had a distal SNU. Patients with carpal instability, humpback deformities, carpal collapse, avascular necrosis, and marked degenerative change were excluded. Following frame application, the treatment comprises three stages: The frame is distracted by 1&amp;nbsp;mm per day until the radiographs show a 2-3&amp;nbsp;mm opening at the SNU site (mean 10&amp;nbsp;days); the SNU site is compressed for 5&amp;nbsp;days, at a rate of 1&amp;nbsp;mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the wrist is then immobilized in the Ilizarov fixator for 8&amp;nbsp;weeks.&lt;/span&gt;&lt;/p&gt;&lt;h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;RESULTS:&lt;/span&gt;&lt;/h4&gt;&lt;p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;Radiographic (radiography and CT scan) and clinical bony union was achieved in all 20 patients after a mean of 90.3&amp;nbsp;days (70-130&amp;nbsp;days). All patients returned to their pre-injury occupations. Thirteen patients had excellent results, four good, and three fair, according to the Mayo wrist score.&lt;/span&gt;&lt;/p&gt;&lt;h4 style="font-size: 13px; margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;CONCLUSIONS:&lt;/span&gt;&lt;/h4&gt;&lt;p style="margin: 0px 0px 0.5em; line-height: 1.538em; font-size: 1.04em; font-family: arial, helvetica, clean, sans-serif;"&gt;&lt;span style="font-size: 10pt;"&gt;In these selected patients, this technique safely achieved bony union without the need to open the SNU site and without the requirement of bone graft.&lt;/span&gt;&lt;/p&gt;

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