Download PDF
CC BY-NC-ND 4.0 · Joints 2019; 07(03): 084-090
DOI: 10.1055/s-0040-1710387
Original Article

Comparison of Shape Memory Staple and Gelled Platelet-Rich Plasma versus Shape Memory Staple alone for the Treatment of Waist Scaphoid Nonunion: A Single-Center Experience

Rocco De Vitis  ‡   *
1   Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
2   Università Cattolica del Sacro Cuore, Rome, Italy
,
Marco Passiatore  ‡   *
1   Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Andrea Perna 
1   Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Giulio Fioravanti Cinci 
1   Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Giuseppe Taccardo 
1   Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
2   Università Cattolica del Sacro Cuore, Rome, Italy
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Purpose The aim of this study was to analyze the results of two different methods of surgical treatment of waist scaphoid nonunions (SNUs). We retrospectively analyzed data from 87 patients referred to our department from January 2010 to December 2017 who were surgically treated for waist SNU.

Methods The mean period of time passed from trauma was 11.2 (±5.6) months. Patients were divided into two groups based on surgical treatment received: volar exposure osteosynthesis with shape memory staple (SMS) (group A) and volar exposure osteosynthesis with SMS and gelled platelet-rich plasma (GPRP) application at the bone defect level (group B). A cast (thumb excluded) was maintained for 4 weeks. Healing was checked clinically (pain, QuickDASH [Disabilities of the Arm, Shoulder, and Hand] score, Mayo Wrist Score) and radiologically (standard X-ray).

Results Union was achieved in 40 patients in group A (95.2%) and in all patients in group B (45 patients; 100%). A statistically significant difference was observed in the improvement of the Mayo Wrist Score, QuickDASH score, and pain (measured through the visual analog scale) after 3 months from surgery (p = 0.02).

Conclusion SMS is effective in treating waist SNU at more than 6 months from trauma. GPRP application can improve bone healing and upper limb function.

Level of Evidence This is a retrospective observational Level III study.

Keywords

scaphoid - staple - scaphoid nonunion - shape memory staple - platelet-rich plasma

* These authors contributed equally to the study.




Publication History

Received: 04 June 2019

Accepted: 04 April 2020

Article published online:
06 May 2020

© 2020. The Author(s). 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 commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Nacif GC, Pedro FMJ, de Moraes VY, Fernandes M, Bellot JC. How scaphoid fractures are treated in Brazil. Acta Ortop Bras 2018; 26 (05) 290-293
    CrossrefPubMedGoogle Scholar
  • 2 Duckworth AD, Jenkins PJ, Aitken SA, Clement ND, Court-Brown CM, McQueen MM. Scaphoid fracture epidemiology. J Trauma Acute Care Surg 2012; 72 (02) E41-E45
    CrossrefPubMedGoogle Scholar
  • 3 Gelberman RH, Menon J. The vascularity of the scaphoid bone. J Hand Surg Am 1980; 5 (05) 508-513
    CrossrefPubMedGoogle Scholar
  • 4 Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci 2006; 11 (04) 424-431
    CrossrefPubMedGoogle Scholar
  • 5 Szabo RM, Manske D. Displaced fractures of the scaphoid. Clin Orthop Relat Res 1988; (230) 30-38
    PubMedGoogle Scholar
  • 6 Hovius SER, de Jong T. Bone grafts for scaphoid nonunion: an overview. Hand Surg 2015; 20 (02) 222-227
    CrossrefPubMedGoogle Scholar
  • 7 Luchetti TJ, Rao AJ, Fernandez JJ, Cohen MS, Wysocki RW. Fixation of proximal pole scaphoid nonunion with non-vascularized cancellous autograft. J Hand Surg Eur Vol 2018; 43 (01) 66-72
    CrossrefPubMedGoogle Scholar
  • 8 Zhang N, Wu YP, Qian SJ, Teng C, Chen S, Li H. Research progress in the mechanism of effect of PRP in bone deficiency healing. ScientificWorldJournal 2013; 2013: 134582
    PubMedGoogle Scholar
  • 9 Acosta-Olivo C, Garza-Borjon A, Simental-Mendia M, Vilchez-Cavazos F, Tamez-Mata Y, Peña-Martinez V. Delayed union of humeral shaft fractures: comparison of autograft with and without platelet-rich plasma treatment: a randomized, single blinded clinical trial. Arch Orthop Trauma Surg 2017; 137 (09) 1247-1252
    CrossrefPubMedGoogle Scholar
  • 10 Gianakos A, Zambrana L, Savage-Elliott I, Lane JM, Kennedy JG. Platelet-rich plasma in the animal long-bone model: an analysis of basic science evidence. Orthopedics 2015; 38 (12) e1079-e1090
    CrossrefPubMedGoogle Scholar
  • 11 Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: a review. Bioact Mater 2017; 2 (04) 224-247
    CrossrefPubMedGoogle Scholar
  • 12 Namazi H, Kayedi T. Investigating the effect of intra-articular platelet-rich plasma injection on union: pain and function improvement in patients with scaphoid fracture. J Hand Microsurg 2016; 8 (03) 140-144
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Passaretti U, Penza A, Fusco M, D'Arienzo A. Il trattamento delle pseudartrosi di scafoide con fattori di crescita. Riv Chir Mano 2006; 43 (03) 258-260
    PubMedGoogle Scholar
  • 14 Filan SL, Herbert TJ. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br 1996; 78 (04) 519-529
    CrossrefPubMedGoogle Scholar
  • 15 Krimmer H, Krapohl B, Sauerbier M, Hahn P. Post-traumatic carpal collapse (SLAC- and SNAC-wrist)--stage classification and therapeutic possibilities [in German]. Handchir Mikrochir Plast Chir 1997; 29 (05) 228-233
    PubMedGoogle Scholar
  • 16 Winkel R, Schlageter M. NITINOL shape memory staple for osteosynthesis of the scaphoid [in German]. Oper Orthop Traumatol 2009; 21 (4-5): 361-372
    CrossrefPubMedGoogle Scholar
  • 17 Van Tassel DC, Owens BD, Wolf JM. Incidence estimates and demographics of scaphoid fracture in the U.S. population. J Hand Surg Am 2010; 35 (08) 1242-1245
    CrossrefPubMedGoogle Scholar
  • 18 Wolf JM, Dawson L, Mountcastle SB, Owens BD. The incidence of scaphoid fracture in a military population. Injury 2009; 40 (12) 1316-1319
    CrossrefPubMedGoogle Scholar
  • 19 Garala K, Taub NA, Dias JJ. The epidemiology of fractures of the scaphoid: impact of age, gender, deprivation and seasonality. Bone Joint J 2016; 98-B (05) 654-659
    CrossrefPubMedGoogle Scholar
  • 20 Geoghegan JM, Woodruff MJ, Bhatia R. et al. Undisplaced scaphoid waist fractures: is 4 weeks' immobilisation in a below-elbow cast sufficient if a week 4 CT scan suggests fracture union?. J Hand Surg Eur Vol 2009; 34 (05) 631-637
    CrossrefPubMedGoogle Scholar
  • 21 Clay NR, Dias JJ, Costigan PS, Gregg PJ, Barton NJ. Need the thumb be immobilised in scaphoid fractures? A randomised prospective trial. J Bone Joint Surg Br 1991; 73 (05) 828-832
    CrossrefPubMedGoogle Scholar
  • 22 Dias JJ, Wildin CJ, Bhowal B, Thompson JR. Should acute scaphoid fractures be fixed? A randomized controlled trial. J Bone Joint Surg Am 2005; 87 (10) 2160-2168
    PubMedGoogle Scholar
  • 23 Dunn J, Kusnezov N, Fares A, Mitchell J, Pirela-Cruz M. The scaphoid staple: a systematic review. Hand (N Y) 2017; 12 (03) 236-241
    CrossrefPubMedGoogle Scholar
  • 24 Ferguson DO, Shanbhag V, Hedley H, Reichert I, Lipscombe S, Davis TRC. Scaphoid fracture non-union: a systematic review of surgical treatment using bone graft. J Hand Surg Eur Vol 2016; 41 (05) 492-500
    CrossrefPubMedGoogle Scholar
  • 25 Corrales LA, Morshed S, Bhandari M, Miclau III T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 2008; 90 (09) 1862-1868
    CrossrefPubMedGoogle Scholar
  • 26 Schmidle G, Ebner HL, Klima G. et al. Time-dependent changes in bone healing capacity of scaphoid fractures and non-unions. J Anat 2018; 232 (06) 908-918
    CrossrefPubMedGoogle Scholar
  • 27 Schuind F, Haentjens P, Van Innis F, Vander Maren C, Garcia-Elias M, Sennwald G. Prognostic factors in the treatment of carpal scaphoid nonunions. J Hand Surg Am 1999; 24 (04) 761-776
    CrossrefPubMedGoogle Scholar
  • 28 Rein S, Hanisch U, Schaller H-E, Zwipp H, Rammelt S, Weindel S. Evaluation of bone remodeling in regard to the age of scaphoid non-unions. World J Orthop 2016; 7 (07) 418-425
    CrossrefPubMedGoogle Scholar
  • 29 Saper D, Shah AK, Stein AB, Jawa A. Screw fixation without bone grafting for delayed unions and nonunions of minimally displaced scaphoids. Am J Orthop 2018; 47 (08) 1-8
    CrossrefPubMedGoogle Scholar
  • 30 Slade III JF, Geissler WB, Gutow AP, Merrell GA. Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 20-32
    CrossrefPubMedGoogle Scholar
  • 31 Capo JT, Shamian B, Rizzo M. Percutaneous screw fixation without bone grafting of scaphoid non-union. Isr Med Assoc J 2012; 14 (12) 729-732
    PubMedGoogle Scholar
  • 32 Little CP, Burston BJ, Hopkinson-Woolley J, Burge P. Failure of surgery for scaphoid non-union is associated with smoking. J Hand Surg Br 2006; 31 (03) 252-255
    CrossrefPubMedGoogle Scholar
  • 33 Ganapathi M, Joseph G, Savage R, Jones AR, Timms B, Lyons K. MRI susceptibility artefacts related to scaphoid screws: the effect of screw type, screw orientation and imaging parameters. J Hand Surg Br 2002; 27 (02) 165-170
    CrossrefPubMedGoogle Scholar
  • 34 Ganapathi M, Savage R, Jones AR. MRI assessment of the proximal pole of the scaphoid after internal fixation with a titanium alloy Herbert screw. J Hand Surg Br 2001; 26 (04) 326-329
    CrossrefPubMedGoogle Scholar