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PubMed1991

Biomechanical comparison of cannulated small bone screws: a brief follow-up study.

The compressive forces generated by the ASIF and Herbert small bone cannulated screws were measured in the laboratory with the use of simulated bones and a custom-designed load washer as a means of quantifying their fixation capabilities. Comparative data were also generated for the Herbert scaphoid bone screw and the ASIF 4 mm cancellous screw. The cannulated Herbert bone screw and the ASIF 4 mm cancellous screw were found to have nearly identical compression capabilities. Both generated compression forces approximately five times those of the Herbert scaphoid bone screw. The ASIF small cannulated screw demonstrated a compressive capacity 2 1/2 times that of the Herbert screw.

Biomechanical Phenomena↗
PubMed2004

Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist.

BACKGROUND: Rapid diagnosis of scaphoid bone fracture in the wrist is important so that appropriate treatment can be started. If a fracture is clinically suspected without being visible on radiography, further investigation has to be conducted to reveal a fracture or to rule it out. The objective of this study was to investigate the validity of computed tomographic (CT) scanning and bone scintigraphy compared with the clinical fracture rate during follow-up of 1 year for examining patients with a suspected scaphoid fracture. METHODS: Bone scintigraphy and CT scanning were performed in 29 patients with persistent clinical suspicion of a scaphoid bone fracture 5 to 10 days after trauma. RESULTS: The sensitivity, specificity, and positive and negative predictive values of the CT scan were 100%. The sensitivity, specificity, and positive and negative predictive values of bone scintigraphy were 78%, 90%, 78%, and 90%, respectively. Seven patients showed a fracture on both CT scanning and bone scintigraphy. Eighteen patients showed no fracture on both CT scanning and bone scintigraphy. A false-positive bone scintigram showed up in two patients and a false-negative bone scintigram in another two patients. CONCLUSION: CT scanning is a rapid, simple, valid method for demonstrating or ruling out a scaphoid fracture and is superior to bone scintigraphy.

Adult↗
PubMed1977

[Habitual scapholunar dissociation].

The authors discuss a rare form of wrist injury, involving scapholunar dissociation, which is manifested by subluxation of the scaphoid bone. The radiologic, clinical, and therapeutic aspects are described. The authors also represent a case of their own where the subluxation of the scaphoid bone became habitual.

Adult↗
PubMedDate not supplied

[Radiographic signs of scaphoid union after bone grafting: the analysis of inter-observer agreement and intra-observer reproducibility].

INTRODUCTION: The diagnosis of radiological union of scaphoid bone after bone grafting requires clear evidence of bony trabeculae traversing the graft from the proximal to the distal pole on at least two of four standard scaphoid views. This sign is the only objective assessments of union. Radiographs of the scaphoid taken 18 weeks after operation, however, can be difficult to interpret. This fact led us to question whether radiographs of scaphoid at 18 weeks provide reliable and objective indication of union. OBJECTIVE: Our study was, therefore, designed to determine the reliability of the radiographic diagnosis of scaphoid union after bone grafting by testing the degree of inter-observer agreement and reproducibility. METHODS: Out of 30 sets of the scaphoid bone radiographs after bone grafting taken 18 weeks after operation, 15 of good quality were selected. Each set included four views: postero-anterior, lateral, semi- pronated and semi-supinated. Seven observers were tested: three orthopedic consultants, three residents and one consultant in radiology. Each was presented with 15 sets of radiographs designated from 1 to 15 and each was asked to answer the question: "Are there trabeculae crossing the fracture site?" Possible answers were 'yes' or 'no'. Eight weeks later, the same 15 sets of radiographs were marked in alphabetic order from A to K and presented to the same seven observers. Data was then analyzed and expressed in terms of interobserver agreement in pairs and intra-observer reproducibility. Calculation was done by kappa statistics so that the degree of disagreement was taken into account and allowance was made for chance agreement. Kappa values can vary from -1.0 (complete disagreement) through 1 (chance agreement) to +1 (complete agreement). RESULTS: For all 15 sets of radiographs, the degree of agreement between each pair of observers was illustrated in Table 2. It demonstrated the level of agreement between each pairs of seven observers. The overall median kappa coefficient for inter-observer agreement was 0,46. This value corresponded to "moderate" strength of agreement. Median kappa coefficient for consultant was 0.62, but median kappa coefficient for residents was 0.43. The degree of agreement between the opinions of each observer at his first and at his subsequent reviews of the same set of radiograph after 8 weeks was presented in Table 3. The overall median Kappa coefficient for the intraobserver agreement for all seven observers was 0.54. The ability of seven observers to reproduce their own opinion regarding trabeculae crossing the fracture line was poor to use it for assessment of bone union. CONCLUSION: Our conclusion is that radiographs taken 18 weeks after scaphoid grafting cannot be reliable and reproducible for assessment of bone union.

Bone Transplantation↗
PubMed1995

[Long-term outcome of Matti-Russe-plasty with special reference to late arthrotic damage of the wrist joint].

Corticocancellous grafting was considered the therapy of choice for treating scaphoid bone pseudarthrosis. However, there has been more criticism recently, since this method neither prevents nor stops arthrosis of the wrist in the long term. Ligamental damage with carpal instability often remains untreated. The malposition and shortening of the scaphoid bone also remains uncorrected. Fifty-five patients in who Matti-Russe reconstruction was carried out to treat schaphoid non-union were followed up. The inclusion criteria were that there had been no preoperative arthrosis and no previous operations. The mean period of observation was 10.7 years. The results of the clinical and radiological investigation were compared with the preoperative findings; in addition, there was a control group with untreated scaphoid non-union. It was shown that arthrosis is demonstrable in 69% of the operated patients; in the unoperated patients, this was the case in 95%. Carpal instability was present in 47.1% of the operated patients. However, it does not affect the development of arthrosis. The time interval between accident and operation is crucial for this. The results of this investigation indicate that scaphoid non-union should be treated as soon as possible even if it is asymptomatic.

Adult↗
PubMed1997

MR imaging of clinically suspected scaphoid fractures.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of MR imaging in revealing occult fractures in patients with clinically suspected acute scaphoid fractures who have normal or equivocal findings on radiographs. SUBJECTS AND METHODS: Thirty-six patients underwent MR imaging within 7 days of wrist injury. All had physical findings suggestive of scaphoid fracture. Coronal T1-weighted, short inversion time inversion recovery, and either T2-weighted or proton density-weighted fast spin-echo sequences with fat suppression were used. Follow-up radiographs were obtained at least 2 weeks after MR imaging whenever possible. All imaging studies were reviewed by two musculoskeletal radiologists. RESULTS: MR imaging revealed 22 occult fractures in 20 patients. Thirteen of these 22 fractures were in the scaphoid bone, and nine were in the distal radius. On MR images, 16 patients had no evidence of fracture. Follow-up radiographs were available in 14 of the 20 patients who had occult fracture revealed by MR imaging. Eleven of the 13 occult fractures of the scaphoid bone were followed up (two were lost to follow-up), and 10 of the 11 showed signs of healing. Five of the nine lesions of the distal radius were followed up, and three of these showed evidence of healing fracture. Three patients without MR evidence of a fracture had follow-up radiographs that showed no fracture. Three patients had findings consistent with bone contusion on MR images; in two patients, the contusion was associated with other fractures, and in one patient, the contusion was isolated. CONCLUSION: MR imaging can reveal occult wrist fractures when findings on radiographs are normal or equivocal.

Adult↗
PubMed2001

[Os scaphoideum--functional and clinical anatomy].

1. Scaphoid bone is the largest and clinically most significant bone in the proximal row of the carpal bones. It consists of three sections: proximal and distal pole and scaphoid waist. Extension and radial duction of the hand results in overloading of distal pole of scaphoid and its waist. 2. Nutrient arteries (from radial artery) enter the bone predominantly from the dorsal surface (75%). Functional intraosseous anastomoses do not exist. In 33% of cases proximal scaphoid has no separate nutrient arteries. 3. Scaphoid bone develops from two centres; however, two separate ossification nuclei are quite rare. Non-union of both centres during the early ontogenetic development results in os scaphoideum bipartitum congenitum.

Humans↗
PubMed1997

Radiographically occult scaphoid fractures: value of MR imaging in detection.

PURPOSE: To evaluate the diagnostic value of magnetic resonance (MR) imaging in patients with clinical suspicion of scaphoid fractures and normal initial plain radiographs. MATERIALS AND METHODS: MR imaging was performed within 7 days after trauma in 42 patients with clinical suspicion of scaphoid fractures and normal plain radiographs. T1-weighted spin-echo, T2*-weighted gradient-echo, and short inversion time inversion-recovery (STIR) sequences were performed. MR images were evaluated independently by two radiologists. Six-week follow-up radiographs were used as a standard to diagnose fractures. RESULTS: MR imaging depicted occult fractures of the scaphoid bone in 14 patients (33%), the capitate bone in four (10%), the trapezium in one (2%), and the distal radius in two (5%). All wrist fractures were detected with a combination of STIR and T1-weighted spin-echo sequences. The sensitivity and specificity for detection of radiographically occult fractures of the wrist were 100% each for the first and 95% and 100%, respectively, for the second radiologist with an almost perfect interobserver agreement (K = 0.953). CONCLUSION: MR imaging has a high sensitivity for detection of fractures of the scaphoid bone and wrist not evident on plain radiographs and may enable early diagnosis and treatment.

Adolescent↗
PubMed1983

[Idiopathic ostonecrosis of the scaphoid tarsal bone (Köhler's second disease)].

The authors report 9 cases of major radiological abnormality of the navicular bone, of which only 5 were cases of Köhler's disease. The diagnosis of this disease requires a combination of clinical and radiological signs, the isolated presence of radiological signs only represents abnormalities of ossification which are very common in this bone. The treatment is generally accepted to be plaster immobilisation, but its duration is a topic of debate, varying between 4 and 8 weeks, according to different authors.

Child↗
PubMed1988

Use of the Herbert bone screw for scaphoid nonunions.

The Herbert bone screw was used to treat 22 selected patients with established scaphoid nonunions. The indications for its use included evidence of avascular necrosis, proximal third fracture fragment, previous bone graft, fracture angulation or displacement, and a bipartite scaphoid. Treatment resulted in radiographic and clinical evidence of healing in 16 patients; 4 patients were symptom-free, but had incomplete healing as evidenced by radiograph; and 2 patients had persistent symptoms with radiographic evidence of nonunion.

Adolescent↗
PubMed2005

Segmental fracture of the scaphoid: report of a rare fracture pattern.

INTRODUCTION: To the best of our knowledge, there are no reports in the orthopaedic and trauma literature of true segmental fracture of the scaphoid bone. We present such a case with a brief discussion of the morphology and mechanisms of injury of scaphoid fractures and the problems they present, particularly in diagnosis. CASE HISTORY: A 43-year-old male with polytrauma sustained in a motorcycle road traffic accident was treated at our hospital. His injuries included a fracture initially thought to involve the waist of the scaphoid. Because he had bilateral upper limb injuries, we elected to treat the fracture surgically to facilitate rehabilitation. At the time of surgery, the fracture was noted to be truly segmental, an unsuspected and rare finding. The fracture was internally fixed, with a satisfactory result. DISCUSSION: Scaphoid fracture patterns are generally consistent and predictable, occurring most commonly through the waist of the bone. Mechanism for injury is thought to be hyperextension of the wrist. Comminution, with or without a butterfly fragment, is occasionally seen, as are simultaneous tuberosity fractures. We suggest that the mechanism in this case may have been multiple or secondary trauma, or an effect of loaded rotation. We highlight the need for careful imaging of the scaphoid bone prior to choosing treatment.

Accidents, Traffic↗
PubMed2002

Differences in calcium accumulation between human plantar and palmar aponeuroses.

To elucidate the characteristics of calcium accumulation of human plantar and palmar aponeuroses, the authors determined the calcium content of human plantar and palmar aponeuroses by atomic absorption flame emission spectrophotometry. The subjects consisted of 9 men and 14 women, ranging in age from 61 to 93 yr. In the plantar aponeurosis, the calcium content was significantly higher in the anterior and posterior parts than in the middle part. It is known that pressure distribution under the sole of a foot is higher in the anterior and posterior parts than in the middle part. The present study suggests that the accumulation of calcium in the plantar aponeurosis is related with the pressure distribution under the sole of a foot. The calcium content increased progressively with aging in the anterior part of the plantar aponeurosis, but not in the middle and posterior parts. Regarding the palmar aponeurosis, the calcium content was significantly higher in the anterior and posterior parts in comparison with the middle part. It was found that the calcium content increased progressively with aging in the posterior part of the palmar aponeurosis, whereas it did not increase significantly with aging in the anterior and middle parts. Regarding the relationship between the calcium content of the aponeuroses and the bone mineral density, a significant correlation was found between the calcium content in the anterior part of the palmar aponeurosis and the bone mineral density of the scaphoid bone.

Aged↗
PubMed2004

Interfragmentary compression across a simulated scaphoid fracture--analysis of 3 screws.

PURPOSE: To measure the interfragmentary compression generated across a simulated fracture in cadaveric scaphoids by 3 different headless compression screws. METHODS: A transverse osteotomy was made through the waist of each scaphoid and a load cell to measure compression was interposed between the fragments, which were then fixed internally retrograde with either an Acutrak Standard (n = 10), Acutrak Mini (n = 12), or Bold (n = 10) screw. The surgeon was blinded to the measured compression, which was recorded during screw insertion and for the following 5 minutes. As a measure of scaphoid bone quality the modulus of elasticity of the trabecular bone of each specimen was then calculated from uniaxial compression tests. RESULTS: The mean interfragmentary compression generated by the Acutrak Standard screw was significantly greater and more consistent than the Bold screw or the Acutrak Mini screw. The compression achieved by the Acutrak Standard screw was also more consistent than that obtained by either the Bold or the Acutrak Mini screws as reflected by the lower standard deviation. The mean modulus of elasticity of the scaphoid trabecular bone was similar for each screw group. CONCLUSIONS: The interfragmentary compression generated by the Acutrak Standard screw was significantly greater and more consistent than that generated by either the Bold or Acutrak Mini screws. The compression generated by the Acutrak Standard and Mini screws was significantly better sustained over time than that generated by the Bold screw; however, these differences were small and may not be clinically important. The optimal compression required to promote scaphoid fracture union remains unknown and clinical trials are needed to further evaluate the outcome from using these devices.

Adult↗
PubMed1980

Nonunion of the scaphoid: analysis of the results from bone grafting.

Scaphoid nonunion was treated by bone-grafting techniques in 86 patients with 90 fractures. The volar inlay (Russe) technique had union in 38 of 44 fractures (86%); the dorsal inlay (Matti) technique in 20 of 22 fractures (91%); the dorsal peg graft (Murray) in nine of 18 fractures (50%); and compression screw osteosynthesis in one of six cases (17%). Fourteen patients had secondary arthritis associated with fracture union. Union was more frequent (85%) in 54 undisplaced nonunions than in 36 displaced nonunions (65%). Complications included avascular necrosis, secondary arthrosis, and persistent nonunion. Avascular necrosis in 13 nonunions was treated successfully by inlay grafts in 11, and postoperative avascular necrosis (four nonunions) was resolved after fracture healing in two. The four patients with failed results had the dorsal peg grafting technique. Of 22 persistent nonunions, 16 had secondary arthritis and four had avascular necrosis. The rate of union was increased when Kirschner wire fixation of unstable nonunions was performed. The dorsal and volar inlay techniques had consistently higher rates of union with fewer complications than did the dorsal peg grafting technique.

Adolescent↗
PubMed2004

The morphological and morphometric features of the scaphoid.

This cadaveric study used 200 scaphoid bones (100 left and 100 right) to assess 24 morphological and 11 morphometric parameters. At least one morphometric feature was absent in all scaphoids, though the tubercle and the dorsal sulcus were present in all instances. There were significant differences in the circumferences of the waist and the base of the tubercle, the width of the main sulcus and the secondary height of the tubercle between left and right scaphoids. Detailed knowledge of anatomy and correlations between the anatomical features may help better understanding of clinical problems.

Cadaver↗