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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(05): 588-593
DOI: 10.1055/s-0041-1735830
Artigo de Atualização
Asami

Internal Fixation of Scaphoid Nonunion with Humpback Deformity Using Iliac Graft and Volar Plate: Series of Eight Cases

Article in several languages: português | English
Amanda Favaro Cagnolati 
1   Programa de Cirurgia da Mão, Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Fernanda Ruiz Andrade 
1   Programa de Cirurgia da Mão, Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Luis Guilherme Rosifini Alves Rezende 
1   Programa de Cirurgia da Mão, Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Nilton Mazzer 
2   Divisão da Cirurgia da Mão, Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Raquel Metzker Mendes Sugano 
3   Centro de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
,
Larissa Martins Garcia 
3   Centro de Reabilitação, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Abstract

Objectives The aim of the present article is a clinical and radiographic evaluation of scaphoid nonunion with humpback deformity using an iliac graft and a volar plate.

Methods Eight patients were followed-up prospectively, all male, with a mean age of 39.6 years old, with scaphoid waist nonunion, with an average of 19 months of trauma without previous surgery. The patients were treated with a graft removed from the iliac crest and a 1.5 mm blocked volar scaphoid plate (Medarthis AG, Basel, Switzerland). The patients were followed-up with radiographic evaluations and computed tomography (CT) scans in the preoperative period and 1 month, 3 months, 6 months and 1 year after the operation. The carpal height and the scaphosemilunar and intrascaphoid angles were measured preoperatively, 3 months, and 1 year postoperatively. The function was assessed preoperatively and repeated 1 year postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-related Wrist Evaluation (PWRE scores), as well as by measurement of forceps clamp and wrist and thumb range of motion.

Results All cases were consolidated, with an average time of 3.38 months. Two complications were observed: an infection of the iliac surgical wound and a plaque element placed in the scapholunate space. Two patients opted to remove the implant because they had a painful click at maximum wrist flexion. There was improvement in the parameters of wrist and thumb range of motion and pinch strength in all measurements, with statistical significance for the PRWE and the scapholunate angle.

Conclusion Although our sample was small, we achieved consolidation in all cases; the complications were expected in the literature and there were improvements in the radiographic patterns, in the functional assessment, and in the pain scale of our patients.

Keywords

internal fixation - pseudarthrosis - scaphoid bone - bone plates - transplants

Note

The present study was developed at the Department of Orthopedics and Anesthesiology of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brazil.




Publication History

Received: 16 December 2020

Accepted: 12 April 2021

Article published online:
28 October 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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