Artikel
Comparison of standard wrist CT and HR-pQCT (High Resolution Peripheral Quantitative Computed Tomography) in scaphoid nonunion after avascular bone graft and percutaneous screw fixation
Suche in Medline nach
Autoren
-
Irena Krusche-Mandl
- Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
-
Sabrina Holzer
- Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
-
Arastoo Nia
- Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
-
Janina Patsch
- Medical University of Vienna, Departement of Radiology, Vienna, Austria
-
Stefan Hajdu
- Medical University of Vienna, Departement of Trauma Surgery, Vienna, Austria
-
Jochen Erhart
- Barmherzige Brüder Eisenstadt, Departement of Orthopaedics and Traumatology, Eisenstadt, Austria
| Veröffentlicht: | 6. Februar 2020 |
|---|
Gliederung
Text
Objectives/Interrogation: A surgical treatment option for scaphoid nonunion is avast and requires avascular bone grafting and screw fixation. This requires postoperative 6-16 weeks immobilization until adequate bony consolidation. This is especially problematic as it is mainly young working-age patients. Therefore, the further development of imaging with reduction of exposure to radiation is desirable. HR-pQCT assessment offers a reduction in radiation exposure compared to standard CT. The aim of this pilot study is to compare HR-pQCT with standard CT to assess bony consolidation in scaphoid pseudarthrosis after avascular bony graft and screw fixation.
Methods: Between 02/2011 and 10/2013, prospectively 9 consecutive patients (10 scaphoids) > 16 years with clinically relevant scaphoid pseudarthrosis requiring surgery were included in our clinic using avascular bone graft and screwing. Baseline data was recorded followed by clinical evaluation after 2.4.6 weeks and 3, 6 and 12 months. A standard CT and HR-pQCT scan was performed every 6 weeks and 3 months to compare the assessability of bony consolidation.
Results and Conclusions: All patients were male with a mean age of 26.2 years. In 7 cases the dominant hand was affected (1x both). The accident mechanism was a fall on the extended wrist in 7 patients, in 2 it was not recoverable. In 6 patients there was a DISI preoperatively (average 24 °). Relevant concomitant pathologies were fractures of: radius (intra-articular), forearm, os hamatum and a bony triquetrum tear. Range of Motion (ROM), DASH, patient rated wrist evaluation (PRWE), pinch and grip force selectively on both sides are presented.
HR-pQCT provided at least comparable results in all cases compared to standard CT, although in one case HR-pQCT revealed an early consolidation.
The possibility of a more precise assessment of bony consolidation in scaphoid pseudarthrosis,treated with avascular bony graft and screwing, by HR-pQCT is desirable and could lead to an individualized better evaluation and thus an earlier mobilization.
