Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery.
Introduction: For the treatment of scaphoid non-unions (SNU), different surgical techniques, including vascularized and non-vascularized bone grafts, are applied. Besides stability, vascularity, and the biological situation at the non-union site are important for healing and the appropriate choice o...
| Publicado en: | Archives of Orthopaedic & Trauma Surgery Vol. 138; no. 10; pp. 1395 - 1406 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
Oct2018
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131619655&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131619655 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09368051 NNG jtl: Archives of Orthopaedic & Trauma Surgery issn: 09368051 maglogo: N pubinfo: dt: Oct2018 vid: 138 iid: 10 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 131619655 131619655 NLM30006666 10.1007/s00402-018-2983-0 NLM30006666 131619655 ppf: 1395 ppct: 11 formats: tig: atl: Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery. aug: au: Schmidle, Gernot Ebner, Hannes Leonhard Klauser, Andrea Sabine Fritz, Josef Arora, Rohit Gabl, Markus affil: Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria sug: subj: Carpal Bones Pathology Carpal Bones Injuries Ilium Transplantation Fracture Healing Carpal Bones Fractures, Ununited Pathology Carpal Bones Surgery Fractures, Ununited Fractures, Ununited Surgery Female Young Adult Imaging, Three-Dimensional Algorithms Sclerosis Microscopy, Electron, Scanning Staining and Labeling Middle Age Ilium Blood Supply Adolescence Fracture Fixation Immunohistochemistry Sclerosis Pathology Male Multidetector Computed Tomography Adult Middle Aged: 45-64 years Adolescent: 13-18 years Adult: 19-44 years Female Male ab: Introduction: For the treatment of scaphoid non-unions (SNU), different surgical techniques, including vascularized and non-vascularized bone grafts, are applied. Besides stability, vascularity, and the biological situation at the non-union site are important for healing and the appropriate choice of treatment. We assessed the healing potential of SNUs by histological parameters and compared it to CT parameters of bone structure and fracture location. Based on the results, we developed a CT classification and a treatment algorithm to impact graft selection in SNU surgery.Patients and Methods: Preoperative 2D-CT reformations of 29 patients were analyzed for trabecular structure, sclerosis, and fragmentation of the proximal fragment. The fracture location was assessed on 3D-CT reconstructions and grouped in three zones depending on the potential blood supply. Samples were taken during surgery for histological evaluation. Histological parameters of bone healing were defined and a bone healing capacity score (BHC), reflecting histological bone viability, was calculated. CT findings were compared to BHC, age of SNU, and time to union.Results: Cases with trabecular structure and without fragmentation showed a statistically significant higher BHC. Time to union was significantly faster if trabecular structure was present and sclerosis was absent. In intraarticular proximal pole non-unions, where no blood supply is assumed, the BHC was statistically significantly lower and time to union was longer compared to SNUs of the other locations. A statistically significant correlation between BHC and time to union was found in the proximal and distal fragment with higher BHC associated with faster healing.Conclusions: CT parameters of bone structure and fracture location can reflect histological healing capacity of SNUs. This can guide bone graft selection in SNU surgery. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|