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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-10-2018 | Trauma Surgery

Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Authors: Gernot Schmidle, Hannes Leonhard Ebner, Andrea Sabine Klauser, Josef Fritz, Rohit Arora, Markus Gabl

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2018

Abstract

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.

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Title: Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery
Authors: Gernot Schmidle
Hannes Leonhard Ebner
Andrea Sabine Klauser
Josef Fritz
Rohit Arora
Markus Gabl
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2018
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-018-2983-0

At a glance: The STEP trials

Springer Medicine

Correlation of CT imaging and histology to guide bone graft selection in scaphoid non-union surgery

Abstract

Introduction

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Conclusions

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