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The clinical outcomes of scaphoid nonunion treated with a precisely processed autologous bone screw: a case series

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Metal implants and bioabsorbable implants are frequently used in orthopaedic surgery, but they have some disadvantages. The usefulness of autologous bone has been described, and a method to precisely process autologous bone into implants such as screws and apply the implants clinically has been desired. We created a new system for manufacturing autologous bone screws during surgery and report five cases of scaphoid nonunion treated with precise autologous bone screws made from the tibial cortex using the new system.

Patients and methods

From 2012 through 2017, seven patients were diagnosed with scaphoid nonunion at our hospital and based on the inclusion/exclusion criteria, five of them were analyzed herein. The surgery was performed according to Zaidemberg’s technique. The bone screw in each case was made from autologous tibial cortex using a numerically controlled lathe (model MTS4, Nano Co., Yokohama, Japan) under sterile conditions. The change in each patient's modified Mayo wrist score between the preoperative examination and at the final survey was determined, as were complications.

Results

The median modified Mayo wrist score improved significantly from 65 to 95 points. All patients who were followed for > 2 years fused at a median duration of 3.5 months. Bone regeneration was confirmed at the donor sites in all cases. One fracture at the donor site occurred as a severe complication.

Conclusions

Precisely shaped autologous bone screws manufactured by a computer-assisted machine, together with a vascularized bone graft, may be a useful technique for treating scaphoid nonunions; these screws had good stability and bone replacement. Careful observation of the donor site is required.

Level of evidence

IV.

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References

  1. Blasier DR, Bucholtz R, Cole W et al (1997) Bioabsorbable implants: applications in orthopaedic surgery. Instr Course Lect 46:531–546

    CAS  PubMed  Google Scholar 

  2. Fayad LM, Patra A, Fishman EK (2009) Value of 3D CT in defining skeletal complications of orthopedic hardware in the postoperative patient. AJR Am J Roentgenol 193:1155–1163

    Article  PubMed  Google Scholar 

  3. Hofmann GO (1995) Biodegradable implants in traumatology: a review on the state-of-the-art. Arch Orthop Trauma Surg 114:123–132

    Article  CAS  PubMed  Google Scholar 

  4. Akmaz I, Kiral A, Pehlivan O et al (2004) Biodegradable implants in the treatment of scaphoid nonunions. Int Orthop 28:261–266

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kujala S, Raatikainen T, Kaarela O et al (2004) Successful treatment of scaphoid fractures and nonunions using bioabsorbable screws: report of six cases. J Hand Surg Am 24:68–73

    Article  Google Scholar 

  6. Yi W, Muguo S, Yongquing X et al (2016) Absorbable scaphoid screw development: a comparative study on biomechanics. Ther Clin Risk Manag 12:643–650

    Google Scholar 

  7. Böstman O, Hirvensalo E, Mäkinen J et al (1990) Foreign-body reactions to fracture fixation implants of biodegradable synthetic polymers. J Bone Joint Surg Br 72:592–596

    Article  PubMed  Google Scholar 

  8. Konan S, Haddad FS (2009) The unpredictable material properties of bioabsorbable PLC interference screws and their adverse effects in ACL reconstruction surgery. Knee Surg Sports Traumatol Arthrosc 17:293–297

    Article  PubMed  Google Scholar 

  9. Imade S, Mori R, Uchio U (2012) Treatment of scaphoid nonunion using an autologous bone screw. J Hand Surg Eur 37:899–900

    Article  Google Scholar 

  10. Imade S, Mori R, Uchio Y et al (2009) Effect of implant surface roughness on bone fixation: the differences between bone and metal pegs. J Orthop Sci 14:652–657

    Article  PubMed  Google Scholar 

  11. Kono M, Mori R, Uchio Y (2012) Bone screws have advantages in repair of experimental osteochondreal fragments. Clin Orthop Relat Res 470:2043–2050

    Article  PubMed  Google Scholar 

  12. Langer MF, Unglaub F, Breiter S et al (2019) Anatomy and pathobiomechanics of the scaphoid. Unfallchirurg 122(3):170–181

    Article  CAS  PubMed  Google Scholar 

  13. Hove LM (1999) Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 33:423–426

    Article  CAS  PubMed  Google Scholar 

  14. Kawamura K, Chung KC (2008) Treatment of scaphoid fractures and nonunions. J Hand Surg Am 33:988–997

    Article  PubMed  PubMed Central  Google Scholar 

  15. Quadlbauer S, Pezzei C, Jurkowitsch J et al (2019) Palmar angular stable plate fixation of nonunions and comminuted fractures of the scaphoid. Oper Orthop Traumatol 31:433–446

    Article  CAS  PubMed  Google Scholar 

  16. Mehling IM, Arsalan-Werner A, Wingenbach V et al (2019) Practicability of a locking plate for difficult pathologies of the scaphoid. Arch Orthop Trauma Surg 139:1161–1169

    Article  PubMed  Google Scholar 

  17. Quadlbauer S, Pezzei C, Beer T et al (2019) Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg 139:281–293

    Article  CAS  PubMed  Google Scholar 

  18. Murray G (1934) Bone-graft for non-union of the carpal scaphoid. Br J Surg 22:63–68

    Article  Google Scholar 

  19. Russe O (1960) Fracture of the carpal navicular. Diagnosis, non-operative treatment, and operative treatment. J Bone Joint Surg Am 42:759–768

    Article  PubMed  Google Scholar 

  20. Munk B, Larsen CF (2004) Bone grafting the scaphoid nonunion: a systematic review of 147 publications including 5,246 cases of scaphoid nonunion. Acta Orthop Scand 75:618–629

    Article  PubMed  Google Scholar 

  21. Imade S, Uchio Y, Ozoe N (2012) Superior fixation of machine-made bone pegs over handmade bone pegs. J Orthop Sci 17:619–625

    Article  PubMed  Google Scholar 

  22. Zaidemberg C, Siebert JW, Angrigiani C (1991) A new vascularized bone graft for scaphoid nonunion. J Hand Surg Am 16:474–478

    Article  CAS  PubMed  Google Scholar 

  23. Amadio PC, Berquist TH, Smith DK et al (1989) Scaphoid malunion. J Hand Surg Am 14:679–687

    Article  CAS  PubMed  Google Scholar 

  24. Düppe H, Johnell O, Lundborg G et al (1994) Long-term results of fracture of the scaphoid. A follow-up study of more than thirty years. J Bone Joint Surg Am 76:249–252

    Article  PubMed  Google Scholar 

  25. Filan SL, Herbert TJ (1996) Herbert screw fixation of scaphoid fractures. J Bone Joint Surg 78-B:519–529

    Article  Google Scholar 

  26. Nagatani T, Mori R, Wang Y et al (2010) Optimum predrilled hole size for bone screws used in osteochondral fixation: in vitro biomechanical study and clinical case. J Orthop Sci 15:245–250

    Article  PubMed  Google Scholar 

  27. Izawa H, Hachiya Y, Kawai T et al (2001) The effect of heat-treated human bone morphogenetic protein on clinical implantation. Clin Orthop Pelat Res 390:252–258

    Article  Google Scholar 

  28. Obwegeser JA (1994) Bioconvertible screws made of allogenic cortical bone for osteosynthesis following sagittal split ramus osteotomy without postoperative immobilization. J Craniomaxillofac Surg 22:63–75

    Article  CAS  PubMed  Google Scholar 

  29. Rano JA, Savoy-Moore RT, Fallat LM (2002) Strength comparison of allogenic bone screws, bioabsorbable screws, and stainless steel screw fixation. J Foot Ankle Surg 40:351–356

    Article  Google Scholar 

  30. Hong Y, Brent GP, Stuart DM et al (2006) Biomechanical analysis of tibial strength after harvesting unicortical tibial grafts from two different sites. Foot Ankle Int 27:190–195

    Article  PubMed  Google Scholar 

  31. Siddesh ND, Hitesh HS, Benjamin J (2010) Donor site morbidity following the harvesting of cortical bone graft from the tibia in children. J Child Orthop 4:417–421

    Article  Google Scholar 

  32. Hong Y, Krishn MS, Brent GP et al (2008) Biomechanical analysis of tibial strength after harvesting unicortical tibial grafts of two different lengths. Foot Ankle Int 29:726–729

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University, 89-1, Enya, Izumo, Shimane, 693-8501, Japan

    Takuya Manako, Shinji Imade, Nobuo Yamagami, Soichiro Yamamoto & Yuji Uchio

Authors
  1. Takuya Manako
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  2. Shinji Imade
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  3. Nobuo Yamagami
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  4. Soichiro Yamamoto
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  5. Yuji Uchio
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Corresponding author

Correspondence to Takuya Manako.

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Conflict of interest

YU received a Grant from Terumo Life Science Foundation (2015). The other authors did not receive and will not receive any benefits or funding from any commercial party related directly or indirectly to the subject of this article.

Ethical approval

The Institutional Committee on Ethics at Shimane University School of Medicine approved this study (No. 213).

Consent to participate

The study design was a retrospective case series. Informed consent was obtained from all patients preoperatively.

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Manako, T., Imade, S., Yamagami, N. et al. The clinical outcomes of scaphoid nonunion treated with a precisely processed autologous bone screw: a case series. Arch Orthop Trauma Surg 143, 627–635 (2023). https://doi.org/10.1007/s00402-021-04092-8

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  • DOI: https://doi.org/10.1007/s00402-021-04092-8

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