scaphoid nonunion panel esfahan 16 ordibehesht 95.ppt · microsoft powerpoint - scaphoid nonunion...
TRANSCRIPT
SCAPHOID NONUNIONSCAPHOID NONUNION
PEARLS AND PITFALLS
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?
1‐Evaluate the Alignment1 Evaluate the Alignment
2‐Diagnosis of AVN
MRI Or CT scan
T‐1 or T‐2
With or without contrast enhencement
3‐Degenerative Changes3 Degenerative Changes
SNAC Wrist
• SLACSLAC
S C• SNAC
• SMAC
SLAC ISLAC I
SLAC IISLAC II
SLAC IIISLAC III
SLAC IVSLAC IV
SLAC I SNAC ISLAC I SNAC I
SLAC II SNAC IISLAC II SNAC II
SLAC III SNAC IIISLAC III SNAC III
SLAC IV = SNAC IVSLAC IV SNAC IV
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
Trauma 8 Weeks AgoTrauma 8 Weeks Ago
WHEN THERE IS NO NEED FOR BONE GRAFT?
In subacute fracture and in fibrous or nonunions with normal alignment
and without AVN
When Do You Use Bone Graft?When Do You Use Bone Graft?
Technique and Type of Bone Graft
Approach
Shape of the graftShape of the graft
Vascularized/nonvascularized
Correction of Humpback Deformity (DISI)
• What would be the plan if the proximalWhat would be the plan if the proximal fragment is avascular?
CT scan or MRI?CT scan or MRI?
Various Techniques for 4‐Corner Fusion
4‐Corner v/s Lunocapitate Fusion4 Corner v/s Lunocapitate Fusion
Fixation in Lunocapitate FusionFixation in Lunocapitate Fusion
Excision of Triquetrum in Lunocapitate Fusion
Other reported but less popular htechniques
Styloidectomy andSty(scaphoid is not resected)
Styloidectomy and Scapholunocapitate fusion in SNAC IIfusion in SNAC II
Other reported but less popular htechniques
Resection of distal scaphoid and scapholunocapitate fusion
Other reported but less popular htechniques
• Excisin of proximal pole
• StyloidectomyStyloidectomy
• Trimming of distal pole
• Fusion of the remaining part of Lunocapitate fusion
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