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Practicability of a locking plate for difficult pathologies of the scaphoid

  • Handsurgery
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Abstract

Introduction

Headless compressions screws are the most implanted devices for scaphoid fractures and nonunions. For cases when screw osteosynthesis is not possible, a special locking plate for scaphoid reconstruction has been developed. The purpose of this study was to evaluate the safety and practicability of this device for difficult scaphoid pathologies.

Materials and methods

Between March 2010 and December 2014, 20 patients (age range 16–59 years) were treated with scaphoid locking plate osteosynthesis. In 17 cases it was due to scaphoid nonunion or delayed union and in three cases to treat a complex multi-fragmentary fracture of the scaphoid. Most of the initial fractures were located either in the proximal third (n = 9) or the middle third (n = 8) of the scaphoid.

Results

Mean follow-up was 14.6 ± 8.9 months (range 2–30 months). All three scaphoid fractures (100%) showed bony healing in the CT scan after 2.7 ± 0.6 months. 15 of 17 (88.2%) patients with scaphoid nonunion demonstrated bony healing in the latest CT scan at an average of 6.2 ± 8.1 months (range 2–11 months) after scaphoid reconstruction. Range of motion (extension/flexion) was 104° ± 18.4° (range 80°–150°) and about one third less than the unaffected side. The average grip strength averaged 38.2 kg on the operated side and 44.1 kg on the unaffected side after surgery.

13 plates (65%) had to be removed due to impaction of the plate or protrusion of the screws.

Conclusions

This new locking device for scaphoid reconstruction seems to be a safe, useful and reliable tool in the treatment of difficult nonunions or multi-fragmentary scaphoid fractures. The practicability is convincing and satisfying fusion rates can be accomplished. However, most patients require hardware removal. We recommend using this plate as a rescue option when a stable osteosynthesis is necessary for the healing process and screw fixation has already failed or is not possible.

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Acknowledgements

We thank our librarian Claudia Diemann-Paeth for helping with the literature research.

Author information

Author notes

  1. Isabella Mehling and A. Arsalan-Werner contributed equally to this work.

Authors and Affiliations

  1. Division for Hand Surgery, St. Vincent Hospital Hanau, Am Frankfurter Tor 19, 63450, Hanau, Germany

    Isabella M. Mehling

  2. Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center, Frankfurt am Main, Germany

    A. Arsalan-Werner, V. Wingenbach, J. Seegmüller, M. Schlageter & M. Sauerbier

  3. Academic Hospital of the Goethe University Frankfurt Am Main, Frankfurt am Main, Germany

    A. Arsalan-Werner, V. Wingenbach, J. Seegmüller, M. Schlageter & M. Sauerbier

Authors
  1. Isabella M. Mehling
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  2. A. Arsalan-Werner
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  3. V. Wingenbach
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  4. J. Seegmüller
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Corresponding author

Correspondence to Isabella M. Mehling.

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Conflict of interest

Michael Sauerbier has a consulting contract with Medartis AG, Switzerland. The other authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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All procedures performed in studies involving human participants were in accordance with the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Appendix: case examples

Appendix: case examples


Case example 1


A 43-year-old patient presented with a scaphoid fracture of the proximal third of the scaphoid and a pre-existing cyst of the left wrist.

figure a

After removal of the cyst, cancellous bone was used from the distal radius and osteosynthesis was performed with the angular stable scaphoid plate.

figure b

Four months later CT showed bony healing.

figure c

The plate was removed 6 months after osteosynthesis because of mechanical irritation during wrist flexion. After the hardware removal the patient reported to be highly satisfied with the result. The range of motion for wrist extension and flexion was 140° with free pronation and supination.


Case example 2


A 29-year-old patient presented with scaphoid nonunion on the left side 7 months after scaphoid fracture that had been treated with scaphoid screw elsewhere.

figure d

The CT scans show the nonunion and insufficient fixation of the fragments.

figure e

Revision surgery with removal of the screw and excision of the pseudarthrosis was performed. Cancellous bone graft from the distal radius was used and the scaphoid was stabilized with the locking plate.

figure f

After 8 weeks of immobilization the CT scan showed bony healing.

figure g

The plate was removed after 10 months due to perception of interference by the patient. The patient was very satisfied with the result.

The X-ray in Stecher’s view as well the CT scans show the reconstructed scaphoid.

figure h

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Mehling, I.M., Arsalan-Werner, A., Wingenbach, V. et al. Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 139, 1161–1169 (2019). https://doi.org/10.1007/s00402-019-03196-6

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