Objective: The Objective of this study is to analyze the radiological, clinical and functional outcome of patients with acute unstable scaphoid fracture treated with primary bone grafting and K (Kirschner)-wire fixation Methods:Based on inclusion and exclusion criteria , a prospective observational study was carried out on 21 patients with acute unstable scaphoid fracture who had been treated with primary bone grafting and K-wire fixation from November 2017 to March 2020 and were followed up for a minimum of 24 weeks. The average patient age was 26.9 years. The time from injury to treatment averaged 11days. Surgery was done under Bier’s Block using volar approach. Bone graft was harvested from distal Radius. The mean operating time was 24 minutes.Clinical parameters like tenderness, grip strength and Range of Movement (ROM) at wrist was assessed. The functional outcome was evaluated using Modified Mayo wrist score. Bone union was assessed using serial plain radiographs. Results:Union was achieved in all (100%) at 12 weeks. There was no evidence of Avascular necrosis (AVN) or arthrosis at latest follow up. As per Modified Mayo wrist score, there were 15 excellent,03 good and 03 fair results at the final follow-up. Individuals resumed their routine work at 12 weeks and all were comfortable with heavy works/ sports activity by 24 weeks. Conclusion: Primary bone grafting has a definite role in the management of acute unstable scaphoid fracture by which aquicker and higher rate of union isachieved with minimal complications. Open reduction allows thorough assessment of fracture for better anatomic reduction. Although the type of fixation device hardly contributes for quicker and higher union, but then the use of K-wire for fixation is the only viable option for smaller bony fragments and is more forgiving in terms of its positioning. It has an added advantage in terms of requirement of minimal inventory and thus is a cost-effective modality. This procedure also confirms that the patients could get back to their work earlier hence decreasing economic burden.
We read with interest the case report ‘‘A Gore-Tex ‘newinnominate vein’: a surgical option for complicated bilateral cavopulmonary shunts’’ by Vida et al. [1]. We congratulate the authors for their innovative strategy in tiding over a troublesome situation following the bilateral cavopulmonary shunt (BCPS). However, certain reservations can be expressed over the initial management strategy planned for this patient. In the initial stage alone, considering a right pulmonary artery of only 3 mm size for a 14-month-old child (weight not specified), a left-sided systemic to pulmonary artery shunt would have provided an adequate initial palliation and considering that the pulmonary arteries were confluent, it would have probably led to the growth of the right pulmonary artery [2]. Previous experience has shown adequate growth of the pulmonary arteries after a systemic to pulmonary artery shunt [2], whereas their growth following a cavopulmonary shunt procedure is only a probability, particularly if the pulmonary arteries are not adequate in size [3—5]. Although the systemic to pulmonary artery shunt would have resulted in the volume overload of the systemic ventricle, the subsequent growth of the pulmonary arteries would probably have been better and avoided the unfortunate situation encountered by the authors. The risk of occlusion of the prosthetic graft when used as a systemic to pulmonary artery shunt would also have been less than its risk of occlusion between the two cavae, which the authors were forced to perform. Considering that the child was 14 months old, he could have then returned in the ensuing year for the BCPS with a more favourable pulmonary artery anatomy.
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