ORIGINAL ARTICLE   

Minerva Orthopedics 2023 February;74(1):14-9

DOI: 10.23736/S2784-8469.22.04287-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

The use of titanium custom-made 3D-printed prosthesis with reconstruction of scapholunate interosseous ligament in the treatment of scaphoid nonunion

Chiara STAMBAZZI ^{1, 2} ✉, Giacomo M. GALBIATI ^{1, 2}, Elena CIANCI ^{1, 2}, Andrea ZOCCOLAN ³, Mario I. ROSSELLO ³, Matteo FORMICA ^{1, 2}

¹ Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy; ² IRCCS San Martino Polyclinic Hospital, Genoa, Italy; ³ Department of Hand Surgery, San Paolo Hospital, Savona, Italy

BACKGROUND: Scaphoid non-union with necrosis of bone fragments is a common adverse outcome of conservative and surgical treatment of proximal scaphoid fractures, apart from ignored fractures: if not diagnosed, in long term period can lead to alterations of carpal biomechanics and related carpal and wrist osteoarthritis. Recently the use of custom-made 3D prosthesis, which allows the reconstruction of scapholunate interosseous ligament (SLIL), in the treatment of scaphoid nonunion have been described.
METHODS: In this retrospective study 11 patients with diagnosis of scaphoid nonunion with necrosis of the fragments have been treated with total scaphoid replacement using custom-made 3D implants and reconstruction of SLIL. Pain on Visual Analogue Scale, strength, range of motion, functional (DASH and PRWE Score) and radiographic parameters have been collected at the follow-up and compared to pretreatment values.
RESULTS: At a mean follow-up of 35.64±14.78 months we reported statistically significative improvement of range of motion, pain, symptoms and function. Radiographically none of patients have reported signs of new onset wrist arthritis or progressive carpal collapse at the follow-up. One case of volar subluxation of the prothesis has been observed.
CONCLUSIONS: Total scaphoid replacement with custom made 3D printed prosthesis can be considered a reasonable option for patients with scaphoid nonunion and necrosis of the fragments, allowing the restoration of almost native carpal biomechanics, a good function and range of motion of the wrist.

KEY WORDS: Scaphoid bone; Necrosis; Prostheses and implants; Ligaments