Article
A new minimally invasive technique of the bone marrow concentrate injections improves hand function and reduces pain in the selected scaphoid nonunions
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Authors
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Kaja Gizewska-Kacprzak
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Ireneusz Walaszek
- Department of Orthopeadics, Traumatology and Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Andrzej Bohatyrewicz
- Department of Orthopeadics, Traumatology and Oncology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The scaphoid fractures are the most common carpal bone fractures. Often misdiagnosed can lead to a nonunion. The scaphoid nonunion changes carpal biomechanics and leads to wrist arthrosis. The aim of the study was to evaluate the administration of the autologous bone marrow stem cells in the selected scaphoid nonunions as a new minimally invasive alternative treatment.
Methods: A consecutive series of 28 patients (25 men and 3 women, 17-58 years old, average 30,7 years) with scaphoid nonunions was analysed. The criterion for inclusion were fibrous nonunions with minimal sclerosis changes (up to 1 mm) - grades 2 and 3 in the Slade classification confirmed in a computed tomography scan (Slade 2 - 64,3% (18), Slade 3 - 35,71% (10).
The patients were examined prior and after the treatment using the Visual Analog Pain Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire supplemented with an assessment of the active range of motion (AROM) and the grip strength. An X-ray evaluation was compared with the preoperative findings.
Scaphoid nonunion was identified under a fluoroscopy. Later 2-3 needles were inserted to the scaphoid and nonunion with arthroscopic guidance.
In the second stage of the procedure, 60 ml of bone marrow were aspirated from the anterior iliac crests, later injected into a Harvest BMAC system, centrifuged and concentrated in a cell separator. Two to three ml were injected into the scaphoid bone through previously inserted needles. A splint was applied for 5 weeks.
Results and Conclusions: After the treatment there was an improvement in all measured features: decrease in DASH: p < 0,0001, decrease in VAS: p < 0,0001, increase in grip strength: p = 0,001 and increase in AROM: p= 0,2099.
The highest percentage of patients with positive changes was observed in the reduction of pain (96,4%) and in the DASH score (85,7%). Both in grip strength and in AROM most of the patients presented positive changes. The results were not correlated with patients' age, therefore the outcome was better the older the patients were. There were 2 cases without a bone union, nevertheless with an improvement in DASH and VAS.
There was no significant impact of the initial status on the level of the improvement.
In conclusion, our new minimally invasive technique can be an attractive treatment option for scaphoid nonunions with minimal sclerosis with a significant impact on patients' hand function and pain reduction, improving the quality of life.
