Distal Radius Bone Graft Research Articles

Scaphocapitate arthrodesis with lunate preservation for Kienböck’s disease: prospective outcomes study

PurposeThe study evaluated the efficacy of SC arthrodesis with lunate preservation for treating patients diagnosed with stage IIIB or IIIC Kienböck’s disease, who also exhibit neutral ulnar variance. The study further aimed to explore potential variations in outcomes between patients diagnosed with stage IIIB and IIIC Kienböck’s disease.MethodsThirty-two patients diagnosed with stage IIIB (n = 19) and stage IIIC (n = 13) Kienböck’s disease underwent SC arthrodesis with distal radius bone grafting stabilised by Herbert compression screws. All participants underwent pre- and post-operative assessments including VAS score for pain, ROM, grip strength, MMWS, and the Quick DASH score. Additionally, RS angle, LHI ratio, and CHI ratio were assessed.ResultsFor all patients, the mean operative time was 73 min, follow-up was 45.6 months, time to union was 14 weeks, and time to full return to work was 24 weeks. The rate of union at the arthrodesis site was 91% (29 out of 32 patients) whilst the incidence of postoperative degenerative arthritis was 36% (8 out of 32 patients). Regarding changes in the means of outcomes from pre- to post-operatively, the VAS score decreased from 8.2 to 1.3 and grip strength improved from 36 to 79%. The RS angle was corrected from 59° to 50°. Significant improvements were noted in the mean MMWS from 45 to 75 and QuickDASH score from 78 to 21. However, no significant changes were observed in ROM, LHI, and CHI. There were no significant differences between patients with stage IIIB and stage IIIC in terms of these parameters, except for differences observed in the RS angle, LHI, and CHI preoperatively and in LHI and CHI postoperatively.ConclusionEvidence level: II.Our research demonstrates that SC arthrodesis is a valuable approach for reducing pain, improving grip strength, and enhancing overall function in individuals with advanced Kienböck’s disease. Importantly, our results indicate no notable differences in outcomes between patients diagnosed with stage IIIB or IIIC Kienböck’s disease.

Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation.

Background Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation. Question What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation? Patients and Methods Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review. Range of motion, strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were obtained. Follow-up X-rays were compared with immediate postoperative X-rays. Results At a mean follow-up of 88.9 months, thumb palmar abduction and radial abduction were significantly higher on the operative side ( p = 0.28 and 0.49, respectively). Extension/flexion arc was significantly lower in the operative wrist ( p = 0.148). There was no significant difference between the operative and nonoperative sides with regard to strength. The median postoperative DASH score was 2.9 (interquartile range [IQR]: 8.3). There was no progression of osteoarthritis when immediate postoperative and follow-up X-rays were compared. Radiographic union was observed in six of the seven (85.7%) patients who were able to return to the office for follow-up radiographs. The mean scapholunate and radioscaphoid angles measured on X-rays were within normal anatomic range postoperatively. Conclusions Using nonvascularized distal radius bone graft and screw fixation in the treatment of scaphoid nonunions with associated AVN has favorable radiologic and functional outcomes and should be considered a viable treatment option for this difficult problem.

Arthroscopic treatment of unstable scaphoid fracture and nonunion with two headless compression screws and distal radius bone graft

BackgroundThe treatment of unstable scaphoid fracture and nonunion remains a challenging problem for hand surgeons. Minimally invasive treatment has become the preferred method of treatment.PurposeThis study introduces the arthroscopic technique with two headless compression screws (HCS) fixation and distal radius bone grafting for the treatment of unstable scaphoid fracture and nonunion, aiming to evaluate its clinical and radiological outcomes.MethodsIt was a retrospective study. From January 2019 to February 2021, a total of 23 patients were included in the current study. Among them, 13 patients with unstable scaphoid fracture underwent arthroscopic treatment with two HCS; 10 patients with scaphoid nonunion underwent arthroscopic treatment with two HCS and a distal radius bone graft. The range of motion of the wrist, visual analog scale (VAS), grip strength, the Modified Mayo Wrist Score (MMWS), the Patient-Rated Wrist Evaluation (PRWE) score, and the Disability of the Arm, Shoulder and Hand (DASH) score were collected at preoperatively and the final follow-up. A computed tomography scan of the wrist was performed on each patient to analyze for union and postoperative osteoarthritis during the follow-up period.ResultsSignificant improvement was only observed in wrist extension. Clinical outcomes including grip strength, VAS pain score, MMWS, PRWE score, and DASH score were significantly improved at the final follow-up. In the subgroup analysis, both patients stabilized with either two HCS or a distal radius bone graft and two HCS have improved clinical outcomes after surgery, respectively. All patients achieved union. No screw fixation failure occurred, and no other postoperative complication was observed in any of the patients.ConclusionsThe arthroscopic technique with two-HCS fixation and distal radius bone grafting is a reliable and effective technique for the treatment of unstable scaphoid fracture and nonunion, providing satisfactory union rates and clinical outcomes.

Scaphoid excision and four corner fusion in treatment of scapholunate dissociation

The purpose of this study was to evaluate the clinical outcome, union rate, and complications of a consecutive series of scaphoid excision and four-corner arthrodeses performed by a three surgeon using distal radius bone graft Herbert screws or K-wires or cannulated Synthes screws or Flower plate fixation. Mean duration of follow-up was 16 months. The results of the present study revealed that, patient satisfaction is high, and the procedure offers well to excellent pain relief. Advances in surgical exposures, fixation techniques, and implants have allowed for rigid fixation that enables for rapid union and the commencement of early range of motion. Failure rates and complication rates are relatively low, and long-term outcomes have been promising

Distinct Cell-Intrinsic Functional Differences Between Iliac Crest and Distal Radius Autografts

Autologous bone grafts demonstrate osteoconductive, osteoinductive, and osteogenic properties. Hand surgeons commonly augment surgical fixation with autografts to promote fracture healing. This study compared the intrinsic stem cell-like properties of 2 commonly used autograft sources in hand surgery: the iliac crest and distal radius. A total of 9 subjects who received an iliac crest bone graft and distal radius bonegraft harvest as a part of the standard care of distal radius malunion or nonunion correction or scaphoid nonunion open reduction and internal fixation were enrolled in the study. Cells were isolated by serial collagenase digestion and subjected to fibroblast colony-forming units, osteogenesis, and adipogenesis assays. The expression levels of genes involved in osteogenesis and adipogenesis were confirmed using quantitative polymerase chain reaction. The cells isolated from the iliac crest bone graft compared with those isolated from the distal radius bone graft demonstrated significantly higher mean fibroblast colony-forming unit efficiency; increased osteogenesis, as measured using alizarin red quantification; increased adipogenesis, as measured using oil red O quantification; and higher expression levels of genes involved in osteogenesis and adipogenesis under the respective differentiation conditions. The cells isolated from the iliac crest bone graft demonstrated a higher fibroblast colony-forming unit capacity and an increased capability to undergo both osteogenesis and adipogenesis. Limited evidence exists comparing the intrinsic stem cell-like properties of the iliac crest and distal radius despite the widespread use of each source in hand and wrist surgery. The information from this investigation may assist hand and wrist surgeons with the selection of a source of autograft.

Treatment of scaphoid nonunion with nonvascularized distal radius bone graft and headless cannulated compression screw

Treatment of scaphoid nonunion with nonvascularized distal radius bone graft and headless cannulated compression screw

Palmar Radiocarpal Artery Vascularized Bone Graft for the Unstable Humpbacked Scaphoid Nonunion With an Avascular Proximal Pole

The most challenging scaphoid nonunion is the unstable nonunion with humpbacked collapse coupled with an avascular proximal pole. Dorsal distal radius pedicled vascularized bone grafts (VBGs) are contraindicated in cases of humpback deformity. The free medial femoral condyle VBG is an excellent option but it is an extensive microsurgical procedure with lengthy operative times and dual-limb incisions. In search of a local, volar, vascularized source of bone to treat this challenging subset of scaphoid nonunions, we analyzed our results with a volar distal radius bone graft based on the pedicled palmar radiocarpal artery (PRCA). A prospective cohort of 15 unstable nonunions with avascular proximal pole fragments was treated with the PRCA graft and open reduction internal fixation. Preoperative carpal indices revealed a high degree of instability. All 15 lacked punctate bleeding from the proximal pole. All 15 patients were treated with the PRCA VBG technique and scanned with computed tomography at approximately 6 and 12 weeks to assess for interval healing. All nonunions healed with an average cross-sectional trabeculation score of 70% at week 6and 84% at week 12. Sagittal intrascaphoid angles improved from 50° to 27°, radiolunate angle improved from -20° to -7°, scapholunate angle improved from 86° to 64°, and revised carpal height ratio improved from 1.45 to 1.53, indicating correction of the humpback collapse deformity. Patients were observed an average of 22 months to have no sign of further avascular necrosis. Pedicled PRCA-VBG successfully addresses the dual needs of the humpbacked scaphoid nonunion with an avascular proximal pole while simultaneously limiting dissection to one limb and avoiding the additional complexities of free tissue transfer. Therapeutic II.

The management of proximal pole scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone graft and radial styloidectomy: A midterm outcome study

Background: The management of proximal pole nonunions of scaphoid with avascular necrosis remains the most controversial of all scaphoid fracture nonunions. Various types of vascularised bone grafts have been used to hasten union. We studied the union rate, clinical and functional outcome of 1, 2 intercompartmental supraretinacular arterial bone graft (1, 2 ICSRA) and radial styloidectomy for proximal pole scaphoid nonunion with avascular necrosis. Methods: We retrospectively analysed the four year outcome of vascularised distal radius bone graft (1, 2 ICSRA) and radial styloidectomy in 20 patients treated at our institution for proximal pole scaphoid nonunion with avascular necrosis between 2010 and 2014. Majority of cases (10) presented as failure of adequate immobilization. The average time to surgery from trauma was 14 months and mean duration of follow up was 30 months. Twelve (12) cases had features of early radioscaphoid arthritis. Nonunion and avascular necrosis were confirmed in all cases with radiographs and MRI scan. We followed the technique described by Zaidemberg et al for harvesting the vascualrised bone grafting from the distal radius. Results: Majority of the cases (80%) united by 20 weeks. There was significant improvement in the grip strength and pain postoperatively. Wrist flexion-extension and radial-ulnar deviation arcs improved but was not statistically significant. The Mayo Wrist Score showed 75 percent of patients had an excellent or good outcome. The scapholunate angle also improved from 62.5 deg to 46.5 deg postoperatively. Radiographic union was achieved in sixteen cases (80%) by 20 weeks. Three cases (15%) went for delayed union and achieved bony healing by thirty weeks. One case (5%) developed pintract infecton and progressed to radioscaphoid arthritis. Conclusions: Our study highlights the efficacy of 1,2 ICSRA vascualrised distal radius bone grafting in proximal pole scaphoid nonunions with avascualr necrosis in achieving good union rate with acceptable clinical and functional outcome in this difficult problem. This procedure can be done under regional block without the need for microsurgical set up and costly implants. Vascularised distal radius grafts with radial styloidectiomy is a promising solution for scaphoid proximal nonunions with avascular and early radioscaphoid arthritic changes.

Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft.

Background Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity. Purpose The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm. Patients and Methods Patients with proximal pole scaphoid fragments comprising less than 20% of the entire scaphoid were included. Fixation was accomplished from a dorsal approach with a micro headless compression screw and distal radius bone graft. Six patients were included. Average follow-up was 44 months (range, 11-92). Results Mean proximal pole fragment size was 14% (range, 9-18%) of the entire scaphoid. The mean immobilization time was 6 weeks, time-to-union of 6 weeks, and final flexion/extension arc of 88°/87°. All patients had a successful union, and no patient had deterioration in range of motion, avascular necrosis, or fragmentation of the proximal pole. Conclusion Small diameter screws with a maximal thread diameter of ≤ 2.8 mm can be used to fix the union of proximal pole acute scaphoid fractures comprising less than 20% of the total area with good success. Level of Evidence Therapeutic case series, Level IV.

The Outcome of Using a Jamshidi Biopsy Trocar Needle in a Novel Technique for Bone Grafting in Percutaneous Internal Fixation of Scaphoid Non-Union.

INTRODUCTION:We report the outcome of using a novel technique of minimally invasive internal fixation and distal radius bone grafting using the Jamishidi Trephine needle and biopsy/graft capture device.METHODS:The technique utilises a 8 mm incision at the distal pole of the scaphoid. The non-union is excavated using the standard Acutrak drill. An 8 gauge Jamshidi trephine needle is used to harvest bone graft from the distal radius which is impacted into the scaphoid and fixed with an Acutrak screw. Fifteen patients were available for retrospective review, 14 male, age mean 29.5 (15-56). Average time from injury to surgery was 167 days (45-72). Fractures classified according to Herbert giving 7 D1 and 8 D2 fractures, 14 waist and 1 proximal pole fractures, all of which had no humpback deformity.RESULTS:Sixty-six percentages of the fractures went onto unite, 4/7 D1 and 6/8 D2 united (p > 0.05). Seventy-five percentages of fracture that had surgery in less than 3 months from time of injury went onto unite, whereas only 63% united in patients who had surgery later than 3 months (p > 0.05). DASH outcome for all patients improved from 86 down to 32 (p < 0.05). With those that united going down from 90 to 6. Those that did not unite went from 81 to 61.CONCLUSION:The Jamshidi bone grafting technique shows comparable results (union rate 66%) to other techniques published in the literature (27-100%) providing the surgeon with an alternative and less demanding procedure than open scaphoid non-union surgery.

Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion)

Bizarre parosteal osteochondromatous proliferation, also known as Nora lesion, is a rare benign surface lesion of the bone commonly affecting the hands and feet. It has an aggressive local growth pattern and high rate of recurrence post-excision. The authors report a case of recurred Nora lesion involving thumb metacarpal neck. En bloc resection with immediate reconstruction using distal radius bone graft was provided as a treatment with no clinical or radiological recurrence at 2-year follow-up.

Distal Radius Bone Graft From the Second Extensor Compartment: A Safe and Effective Technique.

We describe a technique for harvesting cancellous bone graft from the floor of the second extensor compartment that is both easy and effective. It confines surgery to a single operative field under the same regional anesthesia and tourniquet as the primary hand surgical procedure while at the same time allowing wide visualization for harvesting bone graft. It provides cancellous bone of sufficient quality and quantity for use in most hand surgical cases. The technique has so far been used in 80 patients and has proven to be very safe.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases.

Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.

Four-corner arthrodesis using distal radius bone grafting

Purpose The aim of the study was to review the clinical and radiographic results of four-corner arthrodesis for stages 2 and 3 scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist using 3 Kirschner-wires (3K-wires) and bone graft from distal end of the radius. Patients and methods Twenty patients (scaphoid nonunion advanced collapse, n = 14; scapholunate dissociation, n = 6) underwent four-corner arthrodesis using 3K-wires and distal end radius bone graft and were evaluated for radiographic and clinical success using standard posteroanterior and lateral wrist radiographs and according to modified Mayo Wrist Scoring Chart at 6 and 12 months after surgery. Wrist pains, range of the wrist motion, and grip strength were evaluated at final follow-up. A total of 12 men and eight women were included and their average age at surgery was 38 years. In all, 14 wrists were right and six were left. Results Radiographic film assessment revealed union in all cases after an average period of 7 weeks, a well-preserved radiolunate articular interval at all stages of follow-up examination. Pain classification scores showed that 10 patients were pain free, nine patients complained slight pain with vigorous activities, and only one patient complained moderate pain with vigorous activities. The mean flexion improved from 42 to 70% of the normal side. The mean extension improved from 29 to 65% of the normal side. The mean ulnar deviation improved from 28 to 43% of the normal side. The mean radial deviation improved from 30 to 45% of the normal side. Grip strength significantly improved from 28% of opposite side preoperatively to 61% postoperatively. Complications occurred in three cases, radial impingement in one patient, ulnar neuritis in one patient, and superficial infection in one patient. Conclusion We have shown that four-corner arthrodesis using K-wires effectively achieves union, provides satisfactory pain relief, restores grip strength, allows return to original job, and preserves functional motion.

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A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.

Treatment of Avascular Proximal Pole Scaphoid Nonunions With Vascularized Distal Radius Bone Grafting

To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments. We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated. Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery. Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment.

Erratum to: Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: a comparative study

Erratum to: Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: a comparative study

Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: a comparative study

The aim of the study is to find whether there is any superiority of the iliac crest bone graft over the distal radius bone graft, in surgery of nonunion of scaphoid fractures. This is a prospective randomized controlled trial comparing 50 patients treated with internal fixation and distal radius bone graft (group 1) and 50 patients in whom iliac crest bone graft was used instead (group 2). The patients donor site pain in the postoperative period was assessed using visual analogue scale. At each follow-up, each patient was evaluated using Quick DASH score and Mayo's scoring system. Minimum follow-up was 3 years. Mean value of visual analogue scale for pain was 7.1 for group 2 and 4.2 for group 1. There was no statistically significant difference between the two groups in terms of range of wrist joint motion, functional scores, union rate and fracture reduction. There is no advantage of the iliac crest over the distal radius graft to justify its greater morbidity.

Four-corner arthrodesis – Does the source of graft affect bony union rate? Iliac crest versus distal radius bone graft

Four-corner arthrodesis is an accepted surgical option for treatment of scapholunate advanced collapse, scaphoid non-union advanced collapse and midcarpal instability. A preferred source of bone graft for performing four-corner arthrodesis is the iliac crest. An alternative and more convenient donor site is the distal radius. The aim of this study was to investigate whether the union rate after four-corner arthrodesis is influenced by the source of bone graft, that is, iliac crest or distal radius. In a retrospective analysis, charts and radiographs of 180 patients were identified. In 109 patients, iliac crest bone grafts were used, whereas 71 patients received distal radius bone grafts. In the iliac crest bone graft group, 101 out of 109 patients obtained a solid radiographic union of the arthrodesis at an average of 10 weeks after surgery, and non-union in eight patients (7.3%). In the distal radius bone graft group, X-rays of 66 patients showed bone union after an average of 10 weeks after surgery as well and five patients with non-union (7.0%) respectively. There was no statistical difference in bone union. Our data show that distal radius bone graft compares equally to iliac crest bone graft in performing four-corner arthrodesis. The advantages of the distal radius bone graft include a minor surgical exposure and the avoidance of using a distant anatomic site with associated donor-site morbidity.

The application of wrist-spanning external fixators in the treatment of old distal radius fractures

Objective To analyze the results of distal radius limited open reduction and trans-articular fixation with external fixators for treatment of old distal radius fractures.Methods From March 2006 to March2008,16 patients with 18 old distal radius fractures were treated with open reduction and trans-articular fixation with wrist spanning external fixators.Their average age was 52.6 years(29 to 72 years).There were 15 Colles fractures in 13 patients and 3 Smith fractures in 3 patients.The external fixation was used after distal radius fracture reduction and bone grafting for reduction maintenance and static immobilization.Results All the patients were followed up for 4 to 30 months(average 16 months).The time to achieve bone healing ranged from6 to 12 weeks(average 8.7 weeks).According to Cartland and Werley wrist scores,the functional results were rated as excellent in 11 cases,good in 4 cases and fair in 3 cases,with an overall 83.3% excellent and good rate.Conclusion Distal radius limited open reduction and trans-articular fixation with external fixators is an effective method to treat old distal radius fractures.This is a simple procedure with minimal soft tissue damage,which can facilitate early postoperative rehabilitation and promote bone healing. Key words: Fractures,bone; External fixators; Radius