Article
The Surgical Diamond Initiative (SDI) – An Alternative Graft Fixation Technique for Scaphoid Nonunions
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Authors
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Werner Knopp
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
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Benedikt Braun
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
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Nils Thomas Veith
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
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Tim Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
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Klaus Draenert
- Zentrum für orthopädische Wissenschaften, ZOW, München, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: With a rate of up to 10% scaphoid nonunion is a common complication. Different therapeutic options exist, all of which have healing rates between 60 - 95% and long healing times.
To accelerate healing time and raise healing rates the current work examines the mosaicplasty technique with the surgical diamond initiative system as an alternative treatment option in a pilot study with 14 patients.
Materials and methods: The SDI procedure uses (water cooled) diamond tools, coated with natural diamonds. By this method, the only artifact visible is a slight demineralization of 20 µm along the cutting line, the trabeculae and cells remain intact. For taking these graft cylinders out, a sharp extractor is used. The set of instruments is based on the “twins principle”: the outer diameter of the smaller tools are 1/10 and 15/100 of a mm, respectively, smaller than the inner diameter of the next following size, thus yielding a press-fit seat of the graft. This press-fit seat of the graft allows an early revascularization of the transplanted graft cylinders: after one week a bony ingrowth of 1500 µm could be shown in histological examinations using the tetracycline labels. This method is routinely used in bone-cartilage transplantation and in this series in the treatment of scaphoid non-unions.
The series consist of 14 patients with scaphoid pseudarthrosis, which had been treated with this new grafting technique by the author. In cases of humpback deformitiy (5 cases), a double graft cylinder technique was used. In 12 of these cases a Herbert screw was used additionally. The follow up was 13,6 months.
Results: Radiographic (CT) and clinical bony union could be achieved in all patients within a range from 2 to 4 months. The pain relief displayed on VAS reached 1.9. According to the Mayo Wrist Score Chart a satisfactory result (69 points) was achieved. The range of motion of the wrist reaches 80% of the uninjured side.
Conclusion: This procedure is a promising alternative procedure in treating scaphoid non-unions which allows an early revascularization of the transplant and early functional treatment.
