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Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate

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

Abstract

Introduction

Scaphoid is the most fractured carpal bone, with a 5–10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing.

Objective

Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery.

Methods

Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation.

Results

In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups.

Conclusion

Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B.

Level of evidence

IV, case series.

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Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials. The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request. The data are not publicly available due to information that could compromise the privacy of research participants.

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Funding

The authors declare that the Medartis® funded the plates required in the study, also the translation and publication costs.

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Authors and Affiliations

  1. Hand Surgery Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, HCFMUSP, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP, 05403-010, Brazil

    Erick Yoshio Wataya, Guilherme Henrique Meneghel, Victor Mores, Renato Martins Xavier & Rames Mattar Junior

  2. Instituto Vita, São Paulo, SP, Brazil

    João Carlos Nakamoto

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  1. Erick Yoshio Wataya
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Contributions

EYW: wrote the original draft of the article; participated in the review; editing process; data curation, conducting the research; investigation process; validation; methodology; supervision. GHM: participated in the review; editing process; data curation, conducting the research; investigation process; validation; methodology; supervision. VM: investigation process and data curation. JCN: methodology and supervision. RMX: methodology and supervision. RMJ: methodology and supervision.

Corresponding author

Correspondence to Guilherme Henrique Meneghel.

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The authors declare no conflicts of interest of any kind.

Ethical approval

This study was approved by Institutional Ethics Committee under opinion number 5.123.861.

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Written informed consent according to the Declaration of Helsinki was obtained from all study participants and in applicable cases their parents or legal guardians.

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Written informed consent was obtained from all patient/parents/legal guardians for publication of this study and any accompanying images and videos. A copy of the written consent is available for review by the Editor of this journal.

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Wataya, E.Y., Meneghel, G.H., Mores, V. et al. Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate. Arch Orthop Trauma Surg 143, 6955–6963 (2023). https://doi.org/10.1007/s00402-023-05003-9

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