scaphoid nonunion panel esfahan 16 ordibehesht 95.ppt · microsoft powerpoint - scaphoid nonunion...
TRANSCRIPT
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SCAPHOID NONUNIONSCAPHOID NONUNION
PEARLS AND PITFALLS
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Nonunion: Main QuestionsNonunion: Main Questions
1‐Is there malalignment? (DISI, humpback)
2‐ Is there AVN?
3 I h d i f i l f ?3‐ Is there degeneration of articular surfaces?
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1‐Evaluate the Alignment1 Evaluate the Alignment
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2‐Diagnosis of AVN
MRI Or CT scan
T‐1 or T‐2
With or without contrast enhencement
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3‐Degenerative Changes3 Degenerative Changes
SNAC Wrist
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• SLACSLAC
S C• SNAC
• SMAC
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SLAC ISLAC I
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SLAC IISLAC II
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SLAC IIISLAC III
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SLAC IVSLAC IV
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SLAC I SNAC ISLAC I SNAC I
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SLAC II SNAC IISLAC II SNAC II
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SLAC III SNAC IIISLAC III SNAC III
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SLAC IV = SNAC IVSLAC IV SNAC IV
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Nonunion: Main QuestionsNonunion: Main Questions
1‐Malalignment? ……………………Standard X‐rays
2‐AVN? …………………………………..MRI
3 D i X d CT3‐ Degeneration………………………X‐ray and CT scan
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Trauma 8 Weeks AgoTrauma 8 Weeks Ago
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WHEN THERE IS NO NEED FOR BONE GRAFT?
In subacute fracture and in fibrous or nonunions with normal alignment
and without AVN
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When Do You Use Bone Graft?When Do You Use Bone Graft?
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Technique and Type of Bone Graft
Approach
Shape of the graftShape of the graft
Vascularized/nonvascularized
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Correction of Humpback Deformity (DISI)
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• What would be the plan if the proximalWhat would be the plan if the proximal fragment is avascular?
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CT scan or MRI?CT scan or MRI?
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Various Techniques for 4‐Corner Fusion
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4‐Corner v/s Lunocapitate Fusion4 Corner v/s Lunocapitate Fusion
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Fixation in Lunocapitate FusionFixation in Lunocapitate Fusion
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Excision of Triquetrum in Lunocapitate Fusion
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Other reported but less popular htechniques
Styloidectomy andSty(scaphoid is not resected)
Styloidectomy and Scapholunocapitate fusion in SNAC IIfusion in SNAC II
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Other reported but less popular htechniques
Resection of distal scaphoid and scapholunocapitate fusion
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Other reported but less popular htechniques
• Excisin of proximal pole
• StyloidectomyStyloidectomy
• Trimming of distal pole
• Fusion of the remaining part of Lunocapitate fusion
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Conclusion:Conclusion:
• Three basic questionsee bas c quest o s• No need for bone graft in subacute fx and in NU with less than 2 mm of sclerosis if the alignment gis nl and AVN doesn’t exist
• Cancellous bone graft in normally aligned NU• FisK wedge graft in case of malaligment DISI• Bone graft is contraindicated if there is intercarpal arthrosis
• Scaphoidectomy and partial fusion