Our Summary

This research paper discusses a study performed on patients who had previously undergone unsuccessful surgeries for a condition called scaphoid nonunion, which is a failure of a broken wrist bone to heal. The bone in question often suffers from a condition called osteonecrosis, where the bone tissue dies due to lack of blood supply. The researchers hypothesized that using a graft from the medial femoral condyle (a part of the thigh bone) could help heal the nonunion, increase blood flow to the area, and restore the bone’s structure leading to better wrist function.

The study included 49 patients who had undergone this graft procedure between May 2005 and September 2016. They found that 84% of the grafts healed within an average of 16 weeks. X-rays showed improved alignment of the wrist bones after surgery, and a trend toward improved grip strength was observed. No significant change in total wrist movement range was noticed.

Additionally, 24 patients who had successful bone union were able to work or attend school full-time, and 88% were satisfied with their wrist function. The researchers concluded that the graft method is effective in most patients with this combination of bone conditions. Factors such as age, smoking status, body mass index, the time taken to perform the surgery, and preoperative x-ray findings were not significant indicators of failure.

FAQs

  1. What is a scaphoid nonunion and how can a graft from the medial femoral condyle help?
  2. What were the primary findings from the study on scaphoid nonunion surgeries performed between May 2005 and September 2016?
  3. What factors were found to not be significant indicators of failure in the graft procedure for scaphoid nonunion?

Doctor’s Tip

One helpful tip a doctor might tell a patient about scaphoid fracture surgery is to follow post-operative instructions carefully to ensure proper healing and minimize the risk of complications. This may include keeping the wrist immobilized as instructed, attending follow-up appointments, and participating in physical therapy to regain strength and range of motion in the wrist. It is important to communicate any concerns or unusual symptoms to your healthcare provider promptly.

Suitable For

Patients who are typically recommended scaphoid fracture surgery include those with:

  • Scaphoid nonunion, where the broken bone fails to heal
  • Osteonecrosis of the scaphoid bone, leading to bone tissue death
  • Failed previous surgeries for scaphoid nonunion
  • Wrist pain, limited range of motion, and impaired grip strength

Overall, patients who have persistent symptoms and functional limitations despite conservative treatments are candidates for scaphoid fracture surgery. It is important to consult with a healthcare provider to determine the best course of treatment based on individual circumstances and medical history.

Timeline

Before scaphoid fracture surgery, a patient typically experiences pain, swelling, and limited movement in the wrist. They may have difficulty gripping or holding objects, and the wrist may feel weak or unstable. X-rays or other imaging tests may be done to confirm the fracture and determine the extent of the damage.

After surgery, the patient will likely experience some pain and discomfort in the wrist, which can be managed with pain medication. They may need to wear a cast or splint to support the wrist and protect the healing bone. Physical therapy may be recommended to help restore strength and range of motion in the wrist.

Over time, the patient will gradually regain function in the wrist as the bone heals and the surrounding tissues recover. Follow-up appointments with the surgeon will be necessary to monitor progress and make any necessary adjustments to the treatment plan. In some cases, additional surgeries or interventions may be needed if complications arise or if the initial surgery is not successful.

What to Ask Your Doctor

  1. What is the success rate of scaphoid fracture surgery using a graft from the medial femoral condyle?

  2. How long does it typically take for the graft to heal and restore bone structure?

  3. Will the surgery improve blood flow to the affected area and increase wrist function?

  4. What are the potential risks and complications associated with this type of surgery?

  5. How soon after the surgery can I expect to return to normal activities or work?

  6. Will I need physical therapy or rehabilitation after the surgery?

  7. What kind of follow-up care and monitoring will be necessary after the surgery?

  8. Are there any lifestyle changes or precautions I should take to ensure the success of the surgery?

  9. What are the alternative treatment options for scaphoid nonunion if the graft surgery is not successful?

  10. Are there any factors, such as age or medical history, that may affect the outcome of the surgery?

Reference

Authors: Pulos N, Kollitz KM, Bishop AT, Shin AY. Journal: J Bone Joint Surg Am. 2018 Aug 15;100(16):1379-1386. doi: 10.2106/JBJS.17.00955. PMID: 30106819