- Email: [email protected]
Arthroscopy for Bennett fractures: A prospective series of 8 cases
Abstracts / Revue de chirurgie orthopédique et traumatologique 100S (2014) e1–e40
Arthroscopie des fractures extra-articulaires du radius distal : les fractures extra-articulaires sont aussi des traumatismes articulaires, à propos de 35 cas P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction In articular distal radius fractures, arthroscopy has demonstrated benefits to diagnose and treat ligament injuries of the wrist, in particular for the triangular fibrocartilage complex (TFCC). For extra-articular radius fractures, this prospective series proposes to assess ligament injuries (especially TFCC) with a systematic wrist arthroscopy. Indeed, the two forearm bones work as a functional unit and the fracture of one bone often induces a fracture of the second one. When the fracture of the second bone does not occur, we can suspect a dissociative ligamentous injury between the 2 bones, especially a TFCC injury. This hypothesis was oriented by our recent series concerning TFCC injuries in Galeazzi fractures. Materials and methods Over a period of one year, 35 extraarticular distal radius fractures were operated on with systematic radiocarpal arthroscopy. Selected patients were younger than 65 years with recent closed surgical extra-articular radius fractures associated or not with an ulnar fracture. We used a locking anatomical compression plate, a 1.9 mm arthroscope with 3 systematic radio-carpal portals: volar radiocarpal, 3-4, 4-5 and an extra 6U portal for TFCC repair. A splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament injuries, duration of surgery; – postoperative: pain, wrist motion (F/E◦ ; P/S◦ ), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results Five patients were only reviewed twice. The TFCC was injured in 21 cases: – with ulnar fractures (n = 20): 8 injuries including 6 radial lesions; – without ulnar fracture (n = 15): 13 injuries including 9 ulnar lesions. One radial TFCC injury and all ulnar lesions were repaired. About strength and motion: – after 3 weeks: F/E: 60/55◦ , P/S 60◦ /70◦ , grasp 23%; – after 6 weeks: F/E: 75/70◦ , P/S 75◦ /80◦ , grasp 52%; – after 12 weeks: F/E: 85/80◦ , P/S 80◦ /80◦ , grasp 88%. We noticed 30 anatomic reductions and none secondary displacement. Time off work was 4 weeks (0–7). Discussion and conclusion Extra-articular radius fractures without ulnar fracture were often associated with TFCC injuries, rather ulnar. Both bone fractures were less associated with TFCC injuries, rather radial. This study is a first step demonstrating a diagnosis interest in systematic wrist arthroscopy for extra-articular radius fractures. In order to demonstrate a prognosis interest in rapidity and quality of recovery, a further comparative study with pronosupination strength and power measurement should be necessary. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.322 39
Arthroscopy for Galeazzi fractures, a way to demonstrate TFCC damage in extra-articular radius fracture: A series of 7 cases Arthroscopie dans les fractures de Galeazzi (7 cas) : introduction à l’intérêt de l’arthroscopie du poignet dans les fractures extra-articulaires du radius P. Croutzet Toulouse, France Adresse e-mail : [email protected]
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Introduction Galeazzi fracture is a trauma associating diaphysal radius fracture and dislocation or subluxation of the distal radio-ulnar joint (DRUJ). Despite an anatomic reduction of the radius, DRUJ impairment, especially injury of triangular fibrocartilage complex (TFCC) may lead to partial instability with secondary pain and stiffness. This prospective case series proposes to perform wrist arthroscopy for Galeazzi fractures in order to diagnose ligamentous injuries and to enable their reparations. Materials and methods Over a period of 18 months, 7 recent Galeazzi closed fractures were operated on with wrist arthroscopy. We used a locking compression plate, a 1.9 mm arthroscope with 3 radio-carpal portals: 3-4, 4-5 and 6U. A dorsal forearm splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament impairment, duration of surgery; – postoperative: pain, wrist motion (flexion/extension; prono/suppination), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results All patients were reviewed 3 times. The triangular ligament was injured in all cases, 3 cases in the radial part, 3 cases in the ulnar part and one both side. All ulnar injuries were repaired systematically. The radial TFCC injuries were only repaired when DRUJ instability persisted despite good reduction of the radius. After osteosynthesis of the radius, DRUJ remained instable in 3 cases, one ulnar lesion, one radial and one both side. The reparation of the triangular ligament improved stability of the DRUJ in 2 cases, one case remained instable despite TFCC reparation. About strength and mobility: – after 3 weeks: F/E: 50/60◦ , P/S 45◦ /45◦ , grasp 20%; – after 6 weeks: F/E: 80/80◦ , P/S 70◦ /60◦ , grasp 45%; – after 12 weeks: F/E: 85/80◦ , P/S 80◦ /75◦ , grasp 80%. We noticed 7 anatomic radius reductions and no secondary displacement. A dorsal DRUJ subluxation was noticed despite the ulnar TFCC repair; none nonunion was reported. Time off work was 7 weeks (4–10). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by good strength. TFCC reparation participate in DRUJ stabilization but was not always sufficient to fully stabilize the DRUJ. A next study with DRUJ MRI and prono-supination strength measurement should participate to demonstrate further benefits of TFCC reparation in Galeazzi fractures. A lesion of the TFCC was noticed in all cases suggesting that TFCC lesion could occur in some other extra-articular distal radius fractures. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.323 40
Arthroscopy for Bennett fractures: A prospective series of 8 cases Traitement arthroscopique des fractures de Bennett : à propos de 8 cas P. Croutzet Toulouse, France E-mail address: [email protected] Introduction The Bennett fracture is a trauma associating an intra-articular fracture of the first metacarpal and a trapeziometacarpal joint subluxation; the prognosis of this trauma depends on quality of reduction and preservation of ligamentous anatomy. This prospective case series aims at demonstrating that arthroscopic procedure for Bennett fractures can improve both the quality of reduction and the preservation of ligamentous anatomy. Materials and methods Over a period of 18 months, 8 intraarticular fractures of the first metacarpal were operated on with arthroscopy. We only retained recent (< 21 days) trauma without extra-articular fracture. We used 2 portals, a 1.9 mm arthroscope,
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Abstracts / Revue de chirurgie orthopédique et traumatologique 100S (2014) e1–e40
percutaneous cannulated screws and an adhesive strip for closure, a gauntlet splint for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – peroperative: ligament impairment, duration of surgery; – postoperative: pain, trapezio-metacarpal motion (AntRetropulsion, Abd-Adduction, Kapandji score), key pinch strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results All patients were reviewed 3 times. The duration of surgery went down from 60 to 20 minutes; a partial fracture of the trapezium was found in 2 cases; the collateral volar-ulnar ligament was impaired in 2 cases. Active range of motion was: – 3 weeks: Ant 30◦ – Retro 0◦ , Abd 20◦ – Add 5◦ , Kapandji 4; – 6 weeks: Ant 50◦ – Retro 10◦ , Abd 40◦ – Add 15◦ , Kapandji 8, key pinch strength 70%; – 12 weeks: Ant 50◦ – Retro 10◦ , Abd 40◦ – Add 15◦ , Kapandji 10, strength 90%. One patient was still experiencing pain under strain after 12 weeks despite good joint stability. We noticed 7 anatomic reductions and no secondary displacement. Time off work was 4 weeks (1–6); time off upper limb sports was 8 weeks (6–12). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by good strength. Arthroscopy seems to be a reliable and efficient procedure for Bennett fractures. Recovery and functional outcomes are at least the same as with an open procedure, whereas arthroscopy reduces morbidity and duration of surgery. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.324 41
Benefits of a double antirotation screw fixation performed with arthroscopy for scaphoid fractures: A prospective series of 9 cases Intérêt d’un vissage double antirotatoire sous arthroscopie dans les fractures du scaphoïde : à propos de 9 cas P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction Consolidation is the main problem of scaphoid fractures. Percutaneous fixations have demonstrated benefits on the one hand and wrist arthroscopy has improved reduction and has prevented osteosynthesis morbidity on the other hand. Fixation is mostly performed with one cannulated screw and the screw’s compression is supposed to avoid rotation. Despite these recent improvements, nonunions still occur and we consider this is partly due to persistent rotation mobility at the fracture site. This prospective series proposes to assess a double screw fixation to maximize compression and avoid rotation, performed with arthroscopy in order to control reduction and to prevent fixation morbidity. Materials and methods Over a period of one year, 9 isolated recent (< 3 months) scaphoid fractures were operated on with double compression screws under wrist arthroscopy. We used cannulated (Ø 2 mm) compression screws, a 1,9 mm arthroscope with three portals: a midcarpal radial, a radiocarpal 3-4, and an occasional 23 instrumental portal. A splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks, a CT-scan after 12 weeks. Analysis criteria were: – perioperative: ligament injuries, duration of surgery;
– postoperative: pain, wrist motion (F/E◦ ; inclinations; P/S◦ ), grasp strength, time off work and sports, radiographic analysis (reduction, ct-scan consolidation, secondary displacement). Results All patients were reviewed three times. Duration of surgery was 45 minutes (30–70), none scapho-lunate ligament injury was noticed. About strength and mobility: – after 3 weeks: F/E: 70/60◦ , I◦ R/I◦ C 5◦ /20◦ , P/S 70◦ /75◦ , grasp 30%; – after 6 weeks: F/E: 80/75◦ , I◦ R/I◦ C 10◦ /25, P/S 75◦ /85◦ , grasp 65%; – after 12 weeks: F/E: 85/80◦ , I◦ R/I◦ C 10◦ /25, P/S 75◦ /85◦ , grasp 90% We noticed 9 anatomic reductions and consolidation in all cases after 12 weeks. Time off work was 3 weeks (0–7). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by a good strength. The double antirotation screw fixation with arthroscopy seems to be a reliable and efficient procedure for scaphoid fractures enabling rapid recovery and safe results. Arthroscopic double-screw scaphoid is a reliable and an effective technique that provides a short convalescence with a lasting result. We considered this procedure as pertinent enough to be used in certain recent scaphoid nonunions. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.325 42
Arthroscopy for scaphoid nonunions: Inception of therapeutics associating mini-invasive surgery with biological treatment, a preliminary series Pseudarthrose du scaphoide sous arthroscopie : vers des thérapeutiques associant chirurgie mini-invasive et traitement biologique P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction Arthroscopic surgery was an improvement for scaphoid fractures; besides, bone-inducing proteins (BMP) were a major improvement in diaphyseal nonunions. However, scaphoid nonunion treatments are still surgical challenges. This preliminary series wants to improve recovery and outcomes of scaphoid nonunion treatments by associating an arthroscopic debridement and double screw fixation on the one hand with a bone inducing protein on the other hand. Materials and methods Over a period of one year, 4 recent (< 1 year) scaphoid nonunions, without osteonecrosis, were operated on with an arthroscopic debridement and double screw fixation associated with a bone inducing protein. We used two cannulated (Ø 2 mm) compression screws, a 1.9 mm arthroscope with four portals, a midcarpal radial and three radiocarpal portals (3-4, 2 et 1-2), a wrist shaver and burr for debridement, a bone morphogenetic protein (eptotermine alpha) was injected into the nonunion site through a 18 gauge needle before full screws’ compression. A splint was kept for 4 weeks followed by active/passive physiotherapy. Physical examination and X-ray were performed after 3 and 6 weeks then CT-scan after 3 and 6 months. Analysis criteria were: – perioperative: presence of arthritis, nonunion tissue, duration of surgery – postoperative: pain, wrist motion (F/E◦ ; inclinations; P/S◦ ), grasp strength, time off work and sports, radiographic analysis (reduction, CT-scan consolidation, secondary displacement). Results Duration of surgery was 60 minutes (50–90), we noticed none scapho-lunate ligament injury, beginning of arthritis in 3 cases and none nonunion tissue in 2 cases. About strength and mobility: – after 6 weeks: F/E: 50/45◦ , I◦ R/I◦ C 5◦ /10◦ , P/S 70◦ /75◦ , grasp 30%; – after 3 months: F/E: 70/60◦ , I◦ R/I◦ C 10◦ /20◦ , P/S 75◦ /80◦ , grasp 55%;
Arthroscopie des fractures extra-articulaires du radius distal : les fractures extra-articulaires sont aussi des traumatismes articulaires, à propos de 35 cas P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction In articular distal radius fractures, arthroscopy has demonstrated benefits to diagnose and treat ligament injuries of the wrist, in particular for the triangular fibrocartilage complex (TFCC). For extra-articular radius fractures, this prospective series proposes to assess ligament injuries (especially TFCC) with a systematic wrist arthroscopy. Indeed, the two forearm bones work as a functional unit and the fracture of one bone often induces a fracture of the second one. When the fracture of the second bone does not occur, we can suspect a dissociative ligamentous injury between the 2 bones, especially a TFCC injury. This hypothesis was oriented by our recent series concerning TFCC injuries in Galeazzi fractures. Materials and methods Over a period of one year, 35 extraarticular distal radius fractures were operated on with systematic radiocarpal arthroscopy. Selected patients were younger than 65 years with recent closed surgical extra-articular radius fractures associated or not with an ulnar fracture. We used a locking anatomical compression plate, a 1.9 mm arthroscope with 3 systematic radio-carpal portals: volar radiocarpal, 3-4, 4-5 and an extra 6U portal for TFCC repair. A splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament injuries, duration of surgery; – postoperative: pain, wrist motion (F/E◦ ; P/S◦ ), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results Five patients were only reviewed twice. The TFCC was injured in 21 cases: – with ulnar fractures (n = 20): 8 injuries including 6 radial lesions; – without ulnar fracture (n = 15): 13 injuries including 9 ulnar lesions. One radial TFCC injury and all ulnar lesions were repaired. About strength and motion: – after 3 weeks: F/E: 60/55◦ , P/S 60◦ /70◦ , grasp 23%; – after 6 weeks: F/E: 75/70◦ , P/S 75◦ /80◦ , grasp 52%; – after 12 weeks: F/E: 85/80◦ , P/S 80◦ /80◦ , grasp 88%. We noticed 30 anatomic reductions and none secondary displacement. Time off work was 4 weeks (0–7). Discussion and conclusion Extra-articular radius fractures without ulnar fracture were often associated with TFCC injuries, rather ulnar. Both bone fractures were less associated with TFCC injuries, rather radial. This study is a first step demonstrating a diagnosis interest in systematic wrist arthroscopy for extra-articular radius fractures. In order to demonstrate a prognosis interest in rapidity and quality of recovery, a further comparative study with pronosupination strength and power measurement should be necessary. Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.322 39
Arthroscopy for Galeazzi fractures, a way to demonstrate TFCC damage in extra-articular radius fracture: A series of 7 cases Arthroscopie dans les fractures de Galeazzi (7 cas) : introduction à l’intérêt de l’arthroscopie du poignet dans les fractures extra-articulaires du radius P. Croutzet Toulouse, France Adresse e-mail : [email protected]
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Introduction Galeazzi fracture is a trauma associating diaphysal radius fracture and dislocation or subluxation of the distal radio-ulnar joint (DRUJ). Despite an anatomic reduction of the radius, DRUJ impairment, especially injury of triangular fibrocartilage complex (TFCC) may lead to partial instability with secondary pain and stiffness. This prospective case series proposes to perform wrist arthroscopy for Galeazzi fractures in order to diagnose ligamentous injuries and to enable their reparations. Materials and methods Over a period of 18 months, 7 recent Galeazzi closed fractures were operated on with wrist arthroscopy. We used a locking compression plate, a 1.9 mm arthroscope with 3 radio-carpal portals: 3-4, 4-5 and 6U. A dorsal forearm splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – perioperative: ligament impairment, duration of surgery; – postoperative: pain, wrist motion (flexion/extension; prono/suppination), grasp strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results All patients were reviewed 3 times. The triangular ligament was injured in all cases, 3 cases in the radial part, 3 cases in the ulnar part and one both side. All ulnar injuries were repaired systematically. The radial TFCC injuries were only repaired when DRUJ instability persisted despite good reduction of the radius. After osteosynthesis of the radius, DRUJ remained instable in 3 cases, one ulnar lesion, one radial and one both side. The reparation of the triangular ligament improved stability of the DRUJ in 2 cases, one case remained instable despite TFCC reparation. About strength and mobility: – after 3 weeks: F/E: 50/60◦ , P/S 45◦ /45◦ , grasp 20%; – after 6 weeks: F/E: 80/80◦ , P/S 70◦ /60◦ , grasp 45%; – after 12 weeks: F/E: 85/80◦ , P/S 80◦ /75◦ , grasp 80%. We noticed 7 anatomic radius reductions and no secondary displacement. A dorsal DRUJ subluxation was noticed despite the ulnar TFCC repair; none nonunion was reported. Time off work was 7 weeks (4–10). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by good strength. TFCC reparation participate in DRUJ stabilization but was not always sufficient to fully stabilize the DRUJ. A next study with DRUJ MRI and prono-supination strength measurement should participate to demonstrate further benefits of TFCC reparation in Galeazzi fractures. A lesion of the TFCC was noticed in all cases suggesting that TFCC lesion could occur in some other extra-articular distal radius fractures. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.323 40
Arthroscopy for Bennett fractures: A prospective series of 8 cases Traitement arthroscopique des fractures de Bennett : à propos de 8 cas P. Croutzet Toulouse, France E-mail address: [email protected] Introduction The Bennett fracture is a trauma associating an intra-articular fracture of the first metacarpal and a trapeziometacarpal joint subluxation; the prognosis of this trauma depends on quality of reduction and preservation of ligamentous anatomy. This prospective case series aims at demonstrating that arthroscopic procedure for Bennett fractures can improve both the quality of reduction and the preservation of ligamentous anatomy. Materials and methods Over a period of 18 months, 8 intraarticular fractures of the first metacarpal were operated on with arthroscopy. We only retained recent (< 21 days) trauma without extra-articular fracture. We used 2 portals, a 1.9 mm arthroscope,
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Abstracts / Revue de chirurgie orthopédique et traumatologique 100S (2014) e1–e40
percutaneous cannulated screws and an adhesive strip for closure, a gauntlet splint for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks. Analysis criteria were: – peroperative: ligament impairment, duration of surgery; – postoperative: pain, trapezio-metacarpal motion (AntRetropulsion, Abd-Adduction, Kapandji score), key pinch strength, time off work and sports, X-ray analysis (reduction, consolidation, secondary displacement). Results All patients were reviewed 3 times. The duration of surgery went down from 60 to 20 minutes; a partial fracture of the trapezium was found in 2 cases; the collateral volar-ulnar ligament was impaired in 2 cases. Active range of motion was: – 3 weeks: Ant 30◦ – Retro 0◦ , Abd 20◦ – Add 5◦ , Kapandji 4; – 6 weeks: Ant 50◦ – Retro 10◦ , Abd 40◦ – Add 15◦ , Kapandji 8, key pinch strength 70%; – 12 weeks: Ant 50◦ – Retro 10◦ , Abd 40◦ – Add 15◦ , Kapandji 10, strength 90%. One patient was still experiencing pain under strain after 12 weeks despite good joint stability. We noticed 7 anatomic reductions and no secondary displacement. Time off work was 4 weeks (1–6); time off upper limb sports was 8 weeks (6–12). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by good strength. Arthroscopy seems to be a reliable and efficient procedure for Bennett fractures. Recovery and functional outcomes are at least the same as with an open procedure, whereas arthroscopy reduces morbidity and duration of surgery. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.324 41
Benefits of a double antirotation screw fixation performed with arthroscopy for scaphoid fractures: A prospective series of 9 cases Intérêt d’un vissage double antirotatoire sous arthroscopie dans les fractures du scaphoïde : à propos de 9 cas P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction Consolidation is the main problem of scaphoid fractures. Percutaneous fixations have demonstrated benefits on the one hand and wrist arthroscopy has improved reduction and has prevented osteosynthesis morbidity on the other hand. Fixation is mostly performed with one cannulated screw and the screw’s compression is supposed to avoid rotation. Despite these recent improvements, nonunions still occur and we consider this is partly due to persistent rotation mobility at the fracture site. This prospective series proposes to assess a double screw fixation to maximize compression and avoid rotation, performed with arthroscopy in order to control reduction and to prevent fixation morbidity. Materials and methods Over a period of one year, 9 isolated recent (< 3 months) scaphoid fractures were operated on with double compression screws under wrist arthroscopy. We used cannulated (Ø 2 mm) compression screws, a 1,9 mm arthroscope with three portals: a midcarpal radial, a radiocarpal 3-4, and an occasional 23 instrumental portal. A splint was kept for 3 weeks followed by an active/passive physiotherapy. Physical examination and X-ray were performed after 3, 6 and 12 weeks, a CT-scan after 12 weeks. Analysis criteria were: – perioperative: ligament injuries, duration of surgery;
– postoperative: pain, wrist motion (F/E◦ ; inclinations; P/S◦ ), grasp strength, time off work and sports, radiographic analysis (reduction, ct-scan consolidation, secondary displacement). Results All patients were reviewed three times. Duration of surgery was 45 minutes (30–70), none scapho-lunate ligament injury was noticed. About strength and mobility: – after 3 weeks: F/E: 70/60◦ , I◦ R/I◦ C 5◦ /20◦ , P/S 70◦ /75◦ , grasp 30%; – after 6 weeks: F/E: 80/75◦ , I◦ R/I◦ C 10◦ /25, P/S 75◦ /85◦ , grasp 65%; – after 12 weeks: F/E: 85/80◦ , I◦ R/I◦ C 10◦ /25, P/S 75◦ /85◦ , grasp 90% We noticed 9 anatomic reductions and consolidation in all cases after 12 weeks. Time off work was 3 weeks (0–7). Discussion and conclusion Functional mobility was regained after 6 weeks, accompanied by a good strength. The double antirotation screw fixation with arthroscopy seems to be a reliable and efficient procedure for scaphoid fractures enabling rapid recovery and safe results. Arthroscopic double-screw scaphoid is a reliable and an effective technique that provides a short convalescence with a lasting result. We considered this procedure as pertinent enough to be used in certain recent scaphoid nonunions. Disclosure of interest The author has not supplied his declaration of conflict of interest. http://dx.doi.org/10.1016/j.rcot.2014.09.325 42
Arthroscopy for scaphoid nonunions: Inception of therapeutics associating mini-invasive surgery with biological treatment, a preliminary series Pseudarthrose du scaphoide sous arthroscopie : vers des thérapeutiques associant chirurgie mini-invasive et traitement biologique P. Croutzet Toulouse, France Adresse e-mail : [email protected] Introduction Arthroscopic surgery was an improvement for scaphoid fractures; besides, bone-inducing proteins (BMP) were a major improvement in diaphyseal nonunions. However, scaphoid nonunion treatments are still surgical challenges. This preliminary series wants to improve recovery and outcomes of scaphoid nonunion treatments by associating an arthroscopic debridement and double screw fixation on the one hand with a bone inducing protein on the other hand. Materials and methods Over a period of one year, 4 recent (< 1 year) scaphoid nonunions, without osteonecrosis, were operated on with an arthroscopic debridement and double screw fixation associated with a bone inducing protein. We used two cannulated (Ø 2 mm) compression screws, a 1.9 mm arthroscope with four portals, a midcarpal radial and three radiocarpal portals (3-4, 2 et 1-2), a wrist shaver and burr for debridement, a bone morphogenetic protein (eptotermine alpha) was injected into the nonunion site through a 18 gauge needle before full screws’ compression. A splint was kept for 4 weeks followed by active/passive physiotherapy. Physical examination and X-ray were performed after 3 and 6 weeks then CT-scan after 3 and 6 months. Analysis criteria were: – perioperative: presence of arthritis, nonunion tissue, duration of surgery – postoperative: pain, wrist motion (F/E◦ ; inclinations; P/S◦ ), grasp strength, time off work and sports, radiographic analysis (reduction, CT-scan consolidation, secondary displacement). Results Duration of surgery was 60 minutes (50–90), we noticed none scapho-lunate ligament injury, beginning of arthritis in 3 cases and none nonunion tissue in 2 cases. About strength and mobility: – after 6 weeks: F/E: 50/45◦ , I◦ R/I◦ C 5◦ /10◦ , P/S 70◦ /75◦ , grasp 30%; – after 3 months: F/E: 70/60◦ , I◦ R/I◦ C 10◦ /20◦ , P/S 75◦ /80◦ , grasp 55%;