Is Bone Grafting Unnecessary in the Treatment of Cystic Scaphoid Pseudoarthrosis?

PURPOSE OF THE STUDY: The basic aim of the treatment of cystic nonunion is to provide stable fi xation and mechanical compression to increase union, but there is no consensus on whether to perform bone grafting in the cystic area or not. The aim of this study was to compare the clinical and radiological results of patients with cystic scaphoid non-union who received open grafting, and internal fi xation and those treated with percutaneous fi xation without grafting. MATERIAL AND METHODS A retrospective evaluation was made of patients included those determined radiologically with Slade and Dodds grade IV scaphoid cystic non-union. Two different surgical procedures were performed. Percutaneous screw fi xation was carried out on the patients in group 1. Open curettage-grafting and screw fi xation were performed on the patients in group 2. Group 1 was comprised of 16 patients treated with percutaneous screw fi xation, and group 2 was comprised of 17 patients who had open curettage-grafting and screw fi xation. RESULTS In the radiological evaluation at the fi nal follow-up examination, union was determined in 12 of the 16 (75%) patients in group 1 and 15 of the 17 (88%) patients in group 2. There was no statistically signifi cant difference between the two groups in terms of union, functional outcomes and complication rates. DISCUSSION In the current study, the union rate was higher in the patients who had open curettage-grafting and fi xation with a headless screw (88%) than in those with percutaneous screw without grafting (75%), but the difference was not determined to be statistically signifi cant. The union rate of the group that received grafting was similar to the rates reported in the literature. CONCLUSIONS We think that both of these techniques may be successfully used for cystic scaphoid nonunions but percutaneous technique should be preferred as it is minimally invasive. Nevertheless, there is a need for further prospective, randomised studies with larger series to have better comparisons. KEY WORDS: scaphoid bone, nonunion, fracture fi xation, internal, bone grafting, bone screws.

Reconstruction of proximal pole scaphoid non-union with avascular necrosis using proximal hamate: A four-case series.

Union of proximal pole scaphoid fracture is challenging because the vascular supply is limited. The avascular necrosis accompanying non-union and progressive fragmentation make surgical reconstruction difficult. The present study aimed to report short-term results of reconstruction with proximal hamate in proximal pole scaphoid non-union with avascular necrosis. Four patients (3 male, 1 female) were assessed for non-union following proximal pole scaphoid fracture. Mean age was 25.7 years (range, 22-35 years). Mean interval between injury and reconstruction was 7.5 years (range, 5-9 years). In 3 patients, no treatment was given following the fracture and in the other internal fixation was performed following cast immobilization. The non-united avascular proximal scaphoid was resected and reconstructed with proximal hamate autograft. Mean follow-up was 14.0 months (range, 9-22 months) after reconstruction. At the last control, cases were evaluated in terms of clinical and functional status, and radiologic union was determined on CT scan. Three patients reported subjective decrease in pain. Mean grip strength proportionally to the unaffected side was 24% (range, 8-51%), mean flexion-extension was 55.3% (range, 21-60%), and radial-ulnar deviation was 63.6% (range, 25-100%). Mean QuickDASH score was 32.3 (range, 13.6-52.2). Union was observed in all patients. Proximal hamate reconstruction provided union and pain relief, but only moderate objective functional results. It can be used as an alternative technique in proximal pole scaphoid non-union with avascular necrosis.

Single-stage open reduction through a medial approach and innominate osteotomy in developmental dysplasia of the hip.

We treated 15 hips (15 patients) with developmental dysplasia by a single-stage combination of open reduction through a medial approach and innominate osteotomy. The mean age of the patients at the time of operation was 20 months (13 to 30). The mean follow-up period was 9.6 years (4 to 14). At the final follow-up, 14 hips were assessed clinically as excellent and one hip as good. Radiologically, ten hips were rated as class I, four as class II and one as class III according to the criteria of Severin. No avascular necrosis was seen. No patient required subsequent surgery. Our results indicate that satisfactory results can be obtained with the single-stage combination of open reduction by the medial approach and innominate osteotomy for developmental dysplasia of the hip in a selected group of children older than 12 months. To our knowledge, no similar combined technique has been previously reported.

Comparison of body composition analysis methods in clinical routine.

BACKGROUND: Skinfold thickness (SFT) and bioelectrical impedance (BIA) are readily available and commonly used techniques in patient monitoring for body composition analysis (BCA) in clinical practise. Another one, dual-energy X-ray absorptiometry (DEXA) method became popular in body composition analysis (BCA) in recent years. Its results have been reported to be quite accurate and precise, in comparison with in vivo or in vitro multiple component reference methods. The aim of the present study was to assess the degree of agreement between SFT and DEXA, and BIA and DEXA methods, in obese and nonobese patients. METHODS: Body fat mass (FM) was measured in 16 nonobese (mean body mass index; BMI = 22.2 +/- 2.2 kg/m(2)) and in 21 obese (BMI = 34.5 +/- 6.1 kg/m(2)) women with DEXA, SFT, and BIA in the same morning. RESULTS: Mean (+/- SD) FM (kg) was 16.3 +/- 5.5, 15.0 +/- 5.1, 14.7 +/- 4.9 in nonobese subjects and 38.8 +/- 10.1, 36.3 +/- 10.0, 37.1 +/- 12.0 in obese patients, by DEXA, SFT and BIA, respectively. Comparison of the DEXA-BIA and DEXA-STF methods showed high correlation in regression line analysis in nonobese subjects as, r(2) = 0.93 and 0.89, respectively. Regression coefficients were 0.84 and 0.75 in obese patients. However, reanalysis of the data by the Bland and Altman method revealed an obvious lack of agreement between the DEXA-BIA and DEXA-SFT methods in obese patients. In addition, FM was underestimated by BIA and SFT as compared to DEXA in both of the study groups. Besides, better precision was obtained by DEXA method among the others. CONCLUSION: The SFT or BIA method would be preferred to monitor BCA in non-obese subjects in clinical routine. However, DEXA should be considered as the method of choice in obese patient monitoring, since reproducibility gains special importance, other than the accuracy in the context.