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PubMed2000

Fifteen minutes bone scintigraphy in patients with clinically suspected scaphoid fracture and normal x-rays.

Occult fractures of the scaphoid bone occur frequently and may lead to non-union. The use of three-phase bone scintigraphy in patients with normal x-rays of the scaphoid after carpal injury is widely advocated.In this study, 40 patients with negative radiographs but clinically suspected scaphoid fracture, all had rapid bone scintigraphy with images taken 15 min after intravenous injection of 99 m-Technetium Hydroxymethylene diphosphonate. The scan was performed approximately 2 weeks after the trauma. We found 8 fractures of the scaphoid bone and 13 fractures of other carpal bones. In 5 cases the images were inconclusive. At follow-up 6 months to 2 years later we found no patients with non-union. We find this rapid version of the bone scan useful as a second line investigation for continuing wrist pain following trauma in the presence of normal radiography. This can result in a reduction in both time and costs required for the diagnostic process. If the results are inconclusive we recommend a delayed image. CT or MRI could also be considered. In rare cases a wrist arthroscopy may be considered.

Adolescent↗
PubMed1977

[Fracture and pseudoarthrosis of the scafoid bone].

Individuality, which is so expressed in medicine has found as well its application in fractures and pseudoarthroses of scaphoid bone. In the treatment of fracture and pseudoarthrosis of scaphoid bone in each case, patient's occupation, age, body constitution, intensity of pains, functional status of fist and extent of osteonecrotic changes should be considered. In our work we have obtained the best results in "early" pseudoarthrosis by surgical treatment according to Matti-u and Russe-u and in the "late" ones by the method of complete extirpation of necrotic scaphoid. As fist and wrist-joint are very mobile, the slightest fist injury can provoke difficult functional disturbances. Therefore, during the treatment of fracture and pseudoarthrosis of scaphoid bone, a special attention should be paid to the consequences, which in these cases should be minimal.

Fracture Fixation↗
PubMed1975

[Osteochondritis dissecans of the carpal scaphoid? (AUTHOR'S TRANSL)].

The article describes a sequestrated portion of the carpal scaphoid bone, which is interpreted as a marginal fragmentation by partial necrosis of the scaphoid bone. In the authors' opinion, earlier writings have not proved incontestably the occurence of a genuine osteochondritis dissecans of the scaphoid bone.

Carpal Bones↗
PubMed1982

[The upper arm plaster cast].

In order to treat the scaphoid bone fracture, the most frequent of all carpal fractures, a long immobilization is necessary. This can only be guaranteed by an upper arm plaster cast eliminating pronation and supination of the forearm. We use a modified plaster cast of Verdan, namely a hinge-type plaster cast applied to the upper arm, allowing flexion and extension but blocking pronation and supination. The indications are: - conservative treatment of scaphoid bone fractures - postoperative retention of scaphoid bone fractures operated upon - insecure osteosynthesis of the forearm shaft - postoperative elbow luxation We apply the Baycast bandage and hinge splints without stop made of V2A steel. Until now, four patients have been treated successfully with the hinge-type plaster cast.

Arm Injuries↗
PubMed2000

The treatment of pseudoarthrosis of the scaphoid by bone grafting and three methods of internal fixation.

OBJECTIVES: To measure the rate of union in patients with pseudoarthosis of the scaphoid, treated with trapezoidal bone grafting as outlined by Fernandez and 1 of 3 methods of internal fixation and to compare unions versus nonunions and potential predictors of union to determine if associations exist. DESIGN: A retrospective radiologic study of scaphoid pseudoarthroses. SETTING: Division of Orthopedic Surgery, Ottawa Hospital, General Site, a tertiary care facility. PATIENTS: Thirty-four patients with nonunion of scaphoid fractures, treated between 1990 and 1997, with an average follow-up of 19.8 months. INTERVENTIONS: Trapezoidal bone grafting and internal fixation with Kirschner (K) wires, an AO cannulated screw or a Herbert screw. OUTCOME MEASURES: The time to union of scaphoid pseudoarthroses and predictors of union, including the classification, location of pseudoarthrosis, type of internal fixation and length of bone graft. RESULTS: The results showed a correlation between the classification and location of the fracture as determined radiologically, and the outcome. There was no correlation between the type of internal fixation used and the outcome, or between the length of the bone graft and the outcome. Twenty-three patients had radiologically demonstrated union after a mean time of 8.2 months; 16 of 24 patients achieved successful union when treated with K-wire implants, after a mean time of 7.2 months. CONCLUSIONS: Trapezoidal bone grafting and internal fixation with K wires is a practical technique, classification and location of the fracture notwithstanding. Time to union is long, and the results may be unpredictable. Use of K wires for internal fixation presents the clinician with an alternative to fixation with either the AO cannulated screw or the Herbert screw, and has the advantages of cost, ease of insertion and accessibility. This method may therefore be the treatment of choice in developing countries. Resection of the area of pseudoarthrosis must include all fibrous tissue and sclerotic bone. The length of graft, within the parameters of this study, did not affect the outcome.

Accidental Falls↗
PubMed2002

Scaphoid (navicular) fractures of the wrist in children: attention to the impacted buckle fracture.

We retrospectively analyzed the radiographic findings in 76 patients with proven scaphoid (navicular) fractures. The purpose of the study was to determine the incidence of the impacted buckle fracture of the scaphoid bone in children. Fourteen of the 76 patients (17%) demonstrated such a fracture, and all of the fractures occurred in the middle or distal third of the scaphoid bone. The mean age of this group of patients was 13.7 years, as compared to the mean age of 15.6 years in the patients with overt transverse fractures. One out of 14 of the patients with a buckle fracture was female. None developed complicating aseptic necrosis. The fractures were most clearly visualized on AP and oblique views of the wrist, and all cases demonstrated edematous thickening of the soft tissues and/or navicular fat pad obliteration adjacent to the scaphoid bone. The use of comparative views was extremely helpful in the detection of this fracture.

Journal Article↗
PubMed1983

Failure of treatment of ununited fractures of the carpal scaphoid. The role of non-compliance.

We studied the results in thirty patients who had grafting of an ununited fracture of the carpal scaphoid bone. Psychiatric evaluations revealed that the thirteen patients who had a non-union of the initial scaphoid bone graft had significant psychiatric problems, whereas the seventeen patients in whom the non-union had healed after initial bone-grafting of the scaphoid did not have psychiatric abnormalities. Technically successful surgical revisions in the first group of patients did not result in significant clinical improvement. We concluded that most failures of the bone grafts were related to non-compliance on the part of the patient and that some of the operations could have been avoided if the underlying psychiatric problems had been recognized preoperatively.

Bone Transplantation↗
PubMed2003

Preiser's disease: identification of two patterns.

PURPOSE: A large series of patients with Preiser's disease was reviewed to compare 2 potentially different categories of this disorder: complete versus partial vascular impairment of the scaphoid bone as determined by magnetic resonance imaging (MRI). METHODS: Nineteen patients with Preiser's disease were identified retrospectively from 2 institutions. Using MRI criteria, 2 disease patterns were identified: diffuse necrosis and/or ischemia of the scaphoid (type 1 disease, 11 cases) and segmental vascular impairment of the scaphoid (type 2 disease, 8 cases). Risk factors for osteonecrosis, treatment methods, and serial radiographs were reviewed in all cases. Sixteen patients were examined for the purpose of this study at an average follow-up of 25 months. RESULTS: MRI signal changes of necrosis and/or ischemia involved 100% of the scaphoid in type 1 cases and on average approximately 42% in type 2 cases (range, 33% to 66%). In type 1 cases, regardless of the treatment used, the scaphoid typically fragmented and collapsed. In type 2 cases, scaphoid architecture was altered minimally after similar treatment methods. A history of wrist trauma was significantly more common in type 2 cases, and the results of treatment were generally better in this group of patients (mean Mayo modified wrist scores, 86 vs 58 points). CONCLUSIONS: This study supports the concept of 2 patterns of scaphoid involvement in Preiser's disease. Type 1 cases are characterized by MRI signal changes of necrosis and/or ischemia involving the entire scaphoid bone. Patients in this group have a propensity for scaphoid deterioration. Type 2 cases have MRI signal changes involving only part of the scaphoid. These patients commonly report a history of wrist trauma, show fewer tendencies toward scaphoid fragmentation, and may have a more favorable clinical outcome.

Adult↗
PubMed2003

Geometry of carpal scaphoid in Thais: anatomical study.

In order to develop new surgical techniques on, and fixation devices for, carpal scaphoid fractures in Thais, the authors determined the mean and standard deviation of the length, width and thickness of 141 carpal scaphoid bones on 93 left and 48 right wrists from the skeletons of 99 Thai males and 42 Thai females. The deceased averaged 60 years (range, 22 to 89). The scaphoid length averaged 25.59 mm; the dorsal width at the distal, middle and proximal poles averaged 14.89, 10.23 and 7.08 mm, respectively; the palmar width at the distal, middle and proximal poles averaged 14.22, 9.81 and 7.44 mm, respectively; and the thickness at the distal, middle and proximal poles averaged 9.77, 10.96 and 9.19 mm, respectively. The authors found no signficant difference (p = 0.96) in the length and width of the Thai carpal scaphoid bone between the left and right wrist. The widths of the dorsal and palmar sides at the distal end were wider than the proximal end and tapered from the distal to the proximal pole. The thicknesses were constant throughout the length of the bone, ranging between 9 and 11 mm.

Adult↗
PubMed2004

[Non-union in os scaphoideum and its surgical treatment: overview of literature].

Authors present an overview of surgical methods used for the treatment of os scaphoideum with a focus on currently most frequent operations. In the period between January 1998 and March 2004, the authors performed 100 operations on the scaphoid bone, of this 54times primary fixation and 46times surgery for non-union in 42 patients. The most frequent method was resection of non-union, implantation of tri-cortical bone graft and internal fixation (17times). This method is considered by the authors optimal in non-unions in the middle third of the bone without signs of avascular necrosis of the roximal pole. In 8 patients with signs of avascular necrosis of the proximal pole and in non-unions in the proximal third, reconstruction was done by vascularized bone graft after Zaidemberg. In case of the finding of a minimal sclerotic line without deformation or shortening of the bone the method of choice was compression of the non-union by a screw (Herbert screw, HBS, Synthes screw) in 8 patients. Intramedullary cancellous bone graft and internal fixation was used in 8 patients. However, the authors do not consider it as an optimal treatment as it does not guarantee preservation of the length of the bone until the healing of the non-union. This surgery was used by the authors only as an alternative when it was not possible to choose another method. Extirpation of the distal scaphoid bone (twice) and proximal carpectomy (twice, of this once together with the dennervation after Wilhelm) were performed in non-unions with marked osteoarthritic changes of the radiocarpal joint. In one patient the proximal pole was excised and replaced by tendon graft. The authors do not have experience in limited intercarpal arthrodesis, but most other authors currently prefer proximal carpectomy to this technically demanding operation.

Adolescent↗
PubMed1998

[Fracture of the scaphoid carpal bone secondary to an intraosseous cyst. Apropos of a case].

The authors report a cases of scaphoid fracture secondary to an intraosseous cyst in a young patient performing a high-risk sport. Intraosseous synovial cyst is a frequent and usually asymptomatic disease. Its aetiology remains controversial. No cases of fracture have been previously described. Our patient may have presented several risk factors for scaphoid fracture secondary to a synovial cyst.

Adult↗
PubMed2001

[Results of basal joint arthrosis treatment--comparison of Epping ligament reconstruction with trapeziectomy alone].

Objective of this study is to compare clinical and radiological results of two different methods of treatment for trapeziometacarpal osteoarthrosis of the thumb. Eighteen patients received operative treatment. An operation according to Epping was performed in eleven cases (collective I), while nine cases were treated with a trapeziectomy only (collective II). The mean follow-up of the first collective was 40 months and 15 months for the second one. The results of the two patient groups were subjected to statistical comparison in a retrospective study. This revealed no significant differences with regard to active range of motion, power, and subjective symptoms, classified according to the Buck-Gramcko score. With a mean of 49 points for the first and 50 points for the second collective, both achieved very good results. However, the mean operating time was significantly shorter in the patients treated with a trapeziectomy only, while the mean distance between the base of the first metacarpal bone and the scaphoid bone was significantly greater in this group. This is surely due to the shorter follow-up of the patients who underwent trapeziectomy only, since further proximalisation has to be expected. We were able to demonstrate that both methods yield equally good results, and hence the simpler technique of trapeziectomy alone should be given preference, at least in the standard situation of a patient, whose intermetacarpal ligaments offer sufficient stability after trapeziectomy.

Carpal Bones↗
PubMed1991

Abductor pollicis longus tendon arthroplasty for treatment of arthrosis in the first carpometacarpal joint.

A retrospective study of 21 hands in 19 patients was carried out to show the results after excision of the os trapezium for the treatment of arthrosis of the first carpometacarpal joint. A technically easy procedure was used that was based on a tendon plasty using the abductor pollicis longus (APL) tendon. Special attention was paid to the effects of compressive load on the stability of the thumb. The mean follow-up time was 25 months (range 11-38) and all patients achieved good mobility. Pain was reduced in all cases but one. In operated hands grip strength was 84% of estimated normal strength and pinch strength 83%. On radiographs of the hands the mean distance between the base of the metacarpal bone and the scaphoid bone was 4.6 mm, this was reduced by 1.9 mm during compression. When radiographs were taken during a compressive load, two dislocations of the thumb base were found that had otherwise been missed.

Aged↗
PubMed1982

[Experiences and results in the treatment of scaphoid fractures and pseudarthroses of the hand with special reference Matti-Russe osteoplasty].

The author deals with the specific problems involved in the diagnosis of scaphoid fractures and the mechanical causes responsible for non-union of the scaphoid bone because of movements of the hand joint and blood supply of the scaphoid bone. Reference is made to details of surgery according to Matti and Matti-Russe which the author considers to be particularly important while assuming that the reader is already familiar with the technique. Emphasis is also placed on the importance of sufficiently long and careful immobilisation and subsequent physiotherapy. Alternative methods of surgery in special cases and advanced non-unions or arthroses of the hand joint are indicated and the results of treatment conducted by the author during the period 1. 1. 1967 to 31. 12. 1979 are tabulated.

Bone Screws↗
PubMed1999

[Occult fractures of the wrist joint: high resolution image magnification roentgen versus MRI].

PURPOSE: To compare the diagnostic value of high definition macroradiography and MRI in patients with the suspicion of occult wrist fractures. MATERIALS AND METHODS: In a prospective study, 23 patients with clinically suspected wrist fractures and normal initial plain radiographs underwent high resolution macroradiography and MR imaging shortly after trauma. Macroradiographs were taken with a microfocus tube using an anode of 0.03-0.3 mm providing a 4x magnification of the wrist, which was obtained in 4 projections. MR images were performed on a 1.0 T MR unit in coronal planes using T1 weighted SE, T2.-weighted 3D GE, and Turbo-STIR sequences. Follow-up radiographs after 6 weeks were used to confirm the diagnosis of a primary occult wrist fracture. RESULTS: Macroradiography depicted 5 wrist fractures: 4 fractures of the scaphoid bone and 1 fracture of the capitate bone. MRI demonstrated 11 fractures (one of them false-positive): 9 fractures of the scaphoid bone and two fractures of the capitate bone. Using macroradiography, the sensitivity for the detection of occult fractures of the wrist was 50% with a specificity of 100%, using MRI the sensitivity was 100% with a specificity of 92%. CONCLUSION: MRI seems to be superior to high resolution macroradiography in the detection of occult scaphoid fractures and thus is recommended in the management of patients with clinically suspected scaphoid fractures not evident on initial plain films.

Adolescent↗
PubMed1993

Anatomic features of the carpal scaphoid: validation of biometric measurements and symmetry with three-dimensional MR imaging.

The goals of reconstructive surgery for scaphoid fracture nonunions include restoration of normal scaphoid length and shape by use of the contralateral scaphoid bone as a geometric model. A literature search revealed limited documentation of normal biometric measurements and no validation of scaphoid anatomic symmetry. A study was performed to provide normative data and evaluate the right-to-left symmetry of specific geometric measurements of the scaphoid. One hundred normal carpal scaphoid bones in 30 healthy subjects and 40 patients were examined with three-dimensional magnetic resonance (MR) imaging. Standardized oblique projections were reconstructed from each three-dimensional data set, and seven biometric measurements of each scaphoid were obtained. Normative data from the study group were obtained by means of analysis of all 100 scaphoids. Right-to-left symmetry was validated with the biometric measurements of both scaphoids in the healthy subjects. These data validate scaphoid symmetry and provide 95% confidence intervals for specific biometric measurements that are used for preoperative planning of surgical reconstruction of scaphoid nonunions.

Adolescent↗
PubMed1991

Bilateral stress fracture of the scaphoid. A case report.

Bilateral stress fractures of the scaphoid bones in a gymnast are reported and discussed with special consideration of the possible differential diagnoses; bipartite scaphoid and pseudarthrosis of the scaphoid bone. The relevance of the mechanical factors involved and the abduction and dorsiflexion of the wrist in gymnastics are suggested as likely pathomechanisms.

Adult↗
PubMed1978

[The typical wrist ganglion].

Occurrence of ganglion on the wrist in the scaphoid region in connection with protuberance of the scaphoid bone is statistically of high significance. As ganglions result from mucoid degeneration of connective tissue following microtraumata, the scaphoid protuberance may cause ganglion to appear most frequently at a localization above the scaphoid bone on the wrist. We suggest that this localization be called 'loco typico'.

Carpal Bones↗