Scaphoid Fracture Non Union
Conditions
Brief summary
the investigators compare the arthroscopic grafting technique with the traditional open technique in th treatment of scaphoid non union as regards the union rate, time to union and functional outcomes to provide the best intervention to the patient
Detailed description
The treatment of scaphoid non union has no gold standard technique so in this study the investigators try to compare the arthroscopic and the open grafting techniques to determine the better technique to achieve union, time to union and the better functional outcomes including wrist range of motion and grip strength as a primary outcome and the secondary outcomes are the operative time, the complications and radiological correction of the hum-back deformity if present.
Interventions
PROCEDUREArthroscopic grafting and k wires fixation
Arthroscopic midrcarpal scaphoid non union debridment and iliac cancellous bone grafting with K wires fixation
PROCEDUREopen scaphoid grafting with K wires fixation
open surgical volar or dorsal scaphoid non union site debridment and application of iliac bone graft and K wires fixation
Sponsors
Ain Shams University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Intervention model description
2 groups one with the arthroscopic grafting combined with percutaneous fixation, the second with opend grafting and fixation by K wires.
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* scaphoid non-union cases * 16 years or older * males or females * independent from chronicity or non-union location and the investigators defined the non union as failure to reach scaphoid union up to 6 months
Exclusion criteria
.Revision scaphoid non-union cases. * Previously operated wrist for any other pathology * Avascular necrosis (AVN) confirmed by intraoperative inspection. * Scaphoid non-union advanced collapse (SNAC) stage 2 and higher. * Any associated wrist pathology that required separate treatment surgical approach.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Mayo modified wrist score | preoperative, at 6 months and at 24 months | A functional score that depends on the patients function and examination from 0 to 100 and the higher the score the higher the outcome |
| wrist radial and ulnar deviation | preoperative, at 6 months and at 24 months | radial and ulnar deviation range of motion |
| grip strength | preoperative , at 6 months and at 24 months | the power of hand grip measured by dynamometer |
| The disability of arm, shoulder and hand score (DASH score) | preoperative , at 6 months and at 24 months | a questionnaire to assess upper limb function from 0 to 100 where the lower the score means better outcome |
| union rate | 6 months | percentage of patients in each arm that achieve bony union |
| time to union | 6 to 24 weeks | the time that patient take to achieve bony union |
| wrist flexion and extension | preoperative, at 6 months and at 24 months | flexion and extension range of motion |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Degree of scaphoid hump back deformity correction | post operative after bony union up to 1 year | Radiological parameter thorough scapholunate angle |
| Operative time | intraoperative | the duration of each operation |
| complications | 2 years post operative | — |
Countries
Egypt
Outcome results
None listed