First experience of arthroscopic treatment of patients with false joint of the middle third scaphoid bone of the hand

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Introduction. Fractures of the scaphoid bone are the most frequent — among wrist bone fractures and in 10— 15% of cases they end with the development of a false joint. The pain is a restriction of movements in the wrist joint, a decrease in the strength of the hand, significantly limiting the working capacity of patients, as a rule, of young and middle age. In recent years, arthroscopic techniques have been widely used to treat non-union scaphoid in the middle third of the rook. Experience in the treatment of false joints of the scaphoid with the use of arthroscopic techniques in the N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics is presented in this review.

Aim of Study: studying the effectiveness of arthroscopy during the healing of the non-union of the scaphoid bone.

Material and methods. In the department of microsurgery and hand injuries. NN. Priorova Ministry of Health of the Russian Federation from 2015 to 2018. 28 patients were treated with non-union scaphoid bone localized in the middle third of the bone’s body. The clinical examination included: measurement of movements in the wrist joint, the strength of the fist grasp; assessment of pain syndrome on a visual analogue scale (VAS), data from the DASH questionnaire; X-ray of the carpal joint in three projections (straight, lateral, ¾), computed tomography.

Results. Consolidation of the non-union scaphoid was achieved in 24(86%) patients within 8 weeks after surgery. Consolidation did not occur in 4 (14%) patients.

Long-term results 6 months after surgery were followed up in 15 patients. The range of motion in the wrist joint was an extension of 68° (from 45° to 90°), the volume of active flexion of the hand, respectively,66° (from 55° to 90º. Pain syndrome on a visual analogue scale (VAS) 1.5points (from 1 to 3 points). Fist grasp strength 6 months after surgery was 41 kg (from 25 to 57 kg). DASH scale after surgery 10.5 points (from 5.5 to 16.3 points).

Conclusion. Arthroscopic resection of the pseudarthrosis of the middle third of the bone with the plastic of the crushed spongy bone autograft from the ileal wing allows for consolidation of the scaphoid bone within 8 weeks. The first experience testifies to the effectiveness of this method and the need for further research in this direction, the analysis of long-term results.

作者简介

I. Golubev

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

Dr. Sci. (Med.), professor, Chief of Department of Microsurgery and Hand trauma

俄罗斯联邦, Moscow

I. Kutepov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

PHd, Md, Priorov National Medical Research Center of Traumatology and Orthopaedics

俄罗斯联邦, Moscow

G. Baliura

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

编辑信件的主要联系方式.
Email: baliura.doctor@gmail.com
ORCID iD: 0000-0002-1656-1406

Graduate Student, Md

俄罗斯联邦, Moscow

M. Merkulov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

Dr. Sci. (Med.), senior recearch scientist of Department of Microsurgery and Hand trauma

俄罗斯联邦, Moscow

O. Bushuev

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

PHd, senior recearch scientist of Department of Microsurgery and Hand trauma

俄罗斯联邦, Moscow

A. Maximov

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

PHd, Md

俄罗斯联邦, Moscow

G. Shiryaeva

N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics

Email: baliura.doctor@gmail.com

PHd, Md

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Arthroscopic accesses to the pseudarthrosis of the scaphoid. Radial and ulnar midcarpal ports.

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3. Fig. 2. Arthroscopic anatomy of the midcarpal joint.

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4. Fig. 3. Pseudoarthrosis zone debridement (a); appearance of the scaphoid after resection of pseudoarthrosis (b).

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5. Fig. 4. Fragmentation spongy bone (a); bone graft filling (b); insertion of a bone graft into the pseudoarthrosis zone (c).

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6. Fig. 5. Patient К.,19 years. Diagnosis: pseudarthrosis of the scaphoid of the right hand. Hand joint function before surgery: a — extension of the hand; b — flexion of the hand.

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7. Fig. 6. Patient К.,19 years. Diagnosis: pseudarthrosis of the scaphoid of the right hand. a — straight projection x-ray; b — ¾ projection x-ray; c — lateral projection x-ray; d — computed tomography.

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8. Fig. 7. Patient К.,19 years. Diagnosis: pseudarthrosis of the scaphoid of the right hand. 8 weeks after surgery. a — x-ray in straight projection; b — x-ray in ¾; c — x-ray in a lateral projection; g — computed tomography, sagittal projection, d — computed tomography, axial projection.

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9. Fig. 8. Patient К.,19 years. 6 months after surgery. a — extension of the hand; b — flexion of the hand.

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10. Fig. 9. Patient K.,19 years. 6 months after surgery. a — x-ray in straight projection; b — x-ray in ¾; c — x-ray in a lateral projection; d — computed tomography, axial projection.

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