The outcome of bone graft surgery for nonunion of fractures of the scaphoid

Data on 806 patients undergoing bone graft surgery for a scaphoid fracture nonunion were retrospectively collected at 19 centres in the United Kingdom. Each centre contributed at least 30 cases. Sufficient data were available in 462 cases to study factors that influenced the outcome of surgery. Overall union occurred in at least 69%, and nonunion in at least 22%, with 9% of cases having ‘uncertain union status’. Union appeared to be adversely influenced by smoking and the time between acute scaphoid fracture and nonunion surgery, with adjusted odds ratios of 1.8 and 2.4, respectively, but neither achieved the pre-determined significance level of 0.003. The type of bone graft (vascular vs non-vascular; iliac crest vs distal radius) did not appear to influence outcome. Further large multicentre prospective studies with clear definitions of ‘union’ and other factors are needed to clarify whether modification of surgical technique can influence union

Factors Influencing Decision-making and Outcome in the Surgical Management of Trigeminal Neuralgia

Objectives The aim was to optimize the algorithm of operative intervention for trigeminal neuralgia (TN).Design A multivariate analysis was undertaken to determine factors that had influenced both the initial choice of surgical intervention and the subsequent outcomes.Setting The study was undertaken with patients who underwent microvascular decompression (MVD) or percutaneous glycerol injection (PGI) for TN between 2007 and 2009.Participants Seventy-one consecutive patients (43 female) were selected.Main Outcome Measures Data were prospectively recorded and included demographics, etiology, and presentation of TN, duration of symptoms, neurovascular contact, and the outcomes of surgery.Results The response rates for MVD and PGI were 96.2% and 87.5%, respectively. The recurrence rates were 9.8% following MVD and 33.3% following PGI. Multivariate analyses confirmed multiple sclerosis and the identification of neurovascular contact as the only factors predictive of the choice of surgical intervention and the risk of recurrence following MVD.Conclusions Our approach to choosing an operative intervention has been validated. The presence of neurovascular contact and the diagnosis of multiple sclerosis influenced the choice of surgery and were predictive of subsequent outcome. Both MVD and PGI offer effective treatment options for TN. Surgery should be offered early when medical management fails