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PubMed1992

Ulnar translation of the scaphoid: an early X-ray sign of rheumatoid arthritis.

The distance between the os trapezium and radius (which we called scaphoid distance) became shorter during the course of rheumatoid arthritis (RA). Measurement of this distance was performed in 600 hands (300 patients), using standard position of patient's hand in supination with permanent angle (15-20%) between the axis of the radius and the axis of the third metacarpal bone (scaphoid distance). This provided a stable distance between the most distal point of the radial styloid process and most proximal point of the os trapezium. The patients were divided into two groups: a control group consisting of 100 patients with no inflammatory joint disease, and a group of 200 patients suffering from RA. Patients suffering from RA with bone erosions had smaller scaphoid distance than those suffering from RA without bone erosions. The ratio between the distance from the distal radius to the most distal point of the third metacarpal bone and scaphoid index was called carpo-metacarpo-scaphoid index. It excluded the constitutional influence on the scaphoid distance. The shorter the scaphoid distance, the bigger the carpo-metacarpo-scaphoid index. The average indexes were: in the control group 7.8 (+/- 0.4), in group 2A with advanced RA 21.1 (+/- 4.1), and in group 2B with early RA without bone changes 12.0 (+/- 1.6). The results were statistically significant. The measurements are easy to perform and may be helpful in the early X-ray diagnosis of RA, when there are no bone erosions, or narrowing of articular spaces.

Adolescent↗
PubMed2001

Vascularized bone grafts for scaphoid nonunions and kienböck's disease.

Vascularized bone grafts offer the ability to transfer bone with viable osteoclasts and osteoblasts with a preserved circulation. The resultant primary bone healing without creeping substitution through necrotic bone is an attractive alternative to conventional bone grafting in aiding or accelerating healing, replacing deficient bone, and revascularizing necrotic bone. Recent advances in the anatomy and physiology of vascularized bone grafts have increased the understanding and ability to apply them to various of carpal maladies. This article focuses on the principles, anatomy, application, and experimental and clinical studies of vascularized bone grafts for the treatment of scaphoid nonunions and Kienböck's disease.

Bone Transplantation↗
PubMed2005

Scaphoid non-union: the role of vascularized grafting in recalcitrant non-unions of the scaphoid.

Achieving union using conventional grafts has a high chance of failure in patients with recalcitrant non-union (persistent pseudarthrosis) of the scaphoid bone, an avascular proximal fragment and previous failed surgeries because of poor host bed vascularity. Eleven patients with long-standing non-union were treated with vascularized pedicle bone grafting and supplementary corticocancellous grafting. Five had screw fixation and six were fixed with K-wires. The average age of the patients was 28 years, average duration of the non-union was 39 months and mean radiological follow-up was 32 months. There were no significant skeletal complications, although two patients developed neuromata. At review, only six of the 11 non-unions were united. Whilst this is a difficult clinical problem and achieving union is a formidable challenge, we believe that there is a role for such extensive surgery in order to achieve good postoperative function.

Adult↗
PubMed2002

Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography.

OBJECTIVE: This study evaluated the diagnostic accuracy of high-spatial-resolution sonography in the diagnosis of occult fractures of the waist of the scaphoid. SUBJECTS AND METHODS: Sonography of the scaphoid bone with a 12-MHz transducer was performed in 54 patients with clinically suspected scaphoid fracture and normal findings on initial radiographs, including specific scaphoid images. Three levels of clinical suspicion were considered: high (20%), moderate (30%), and low (50%). Attention was paid to the continuity of the scaphoid cortex and to the surrounding soft tissues (i.e., hemarthrosis or hematoma). Data from early sonograms were then compared with the results of radiography repeated 10-14 days after the initial trauma. In cases of persistent suspicion despite normal findings on follow-up radiographs, the presence of fracture was evaluated on CT (four patients), MR imaging (one patient), or bone scanning (one patient). RESULTS: Follow-up examinations proved fracture of the scaphoid waist in five patients. In all patients, diagnosis of fracture was suspected on initial sonograms showing cortical disruption associated with soft-tissue abnormalities. There was one false-positive finding and no false-negative results. Using cortical disruption as a diagnostic criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography for the depiction of scaphoid fracture to be 100%, 98%, and 98%, respectively. Using soft-tissue abnormalities alone as a criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography to be 100%, 65%, and 68%, respectively. The overall prevalence of occult fracture was 9%, ranging from 3.7% for low suspicion to 27% for high suspicion of fracture. CONCLUSION: High-resolution sonography is a reliable and accurate method of evaluating occult fractures of the scaphoid waist. Cortical disruption is the diagnostic key. Soft-tissue abnormalities alone lack specificity.

Adolescent↗
PubMed1991

Treatment of ununited fractures of the carpal scaphoid by iliac bone grafts and Herbert screw fixation.

Internal fixation with a Herbert screw was used to treat 70 ununited fractures of the carpal scaphoid. Bone grafts were utilised in all cases of nonunion (56) and in 10 out of 14 with delayed union. The results were assessed at a mean time of 13 months. Definite radiographic union was achieved in 90% of patients after a mean period of postoperative immobilisation of 5.4 weeks. Although the rate of union was basically the same as in Russe's series, the final functional results were better than those obtained by using his technique. The use of an image intensifier is essential to avoid technical problems.

Adolescent↗
PubMed1996

Osteosarcoma of the scaphoid. A case report and review of the literature.

We describe a case of osteosarcoma of the scaphoid bone, which to our knowledge is only the second reported case of osteosarcoma in the carpus. A 38-year-old man complained of intense pain in the right wrist and had curettage and a bone graft for a lesion in the scaphoid. Histological examination showed this to be an osteosarcoma. Below-elbow amputation was performed and adjuvant chemotherapy given. There has been no evidence of recurrence or metastases at 33 months after amputation.

Adult↗
PubMed1992

Bilateral scaphoid ganglion cysts in an adolescent.

We describe an adolescent girl with symptoms secondary to bilateral, symmetrical ganglion cysts of the scaphoid bones. From the roentgenographic and operative findings, it was believed that the cysts were the penetrating type. The patient is among the youngest reported with carpal bone ganglion cysts and the first with bilateral scaphoid cysts completely described in the English-language medical literature.

Adolescent↗
PubMed2003

Resection of the distal pole of the scaphoid for scaphoid nonunion with radioscaphoid and intercarpal arthritis.

PURPOSE: The treatment of scaphoid nonunion with degenerative arthritis poses a clinical problem that is particularly challenging in cases of associated dorsal intercalated segmental instability collapse, radiocarpal and intercarpal degenerative changes, and poor scaphoid bone quality. The purpose of this study was to report our clinical experience performing a distal scaphoid resection for symptomatic scaphoid nonunion in patients with either radioscaphoid or intercarpal arthritis who have had multiple surgeries. METHODS: Nine patients with recalcitrant scaphoid nonunion and associated degenerative arthritis treated by resection of the distal scaphoid fragment were evaluated both clinically and radiographically. Eight patients were male and one patient was female; the average follow-up period was 28.6 months (range, 12-52 mo). RESULTS: Seven patients reported pain with daily use and the remaining 2 patients reported mild pain with light work before surgery, whereas after surgery 4 of the 9 patients had no wrist pain and the remaining 5 patients had only mild pain with strenuous activity. The wrist range of motion improved from 70 degrees (51.4% of the opposite wrist) to 140 degrees (94% of the opposite wrist) and grip strength improved from 18 kg (40% of the opposite wrist) to 30 kg (77% of the opposite wrist). Clinical results were excellent in 6 patients and good in 3 patients based on a modified Mayo wrist-scoring chart. Radiographically neither additional degeneration nor progress of degenerative changes was noted after surgery in 8 patients. Newly developed degenerative arthritis occurred at the proximal scapholunate capitate articulation in the remaining patient who has a type II lunate, which had a facet (medial facet) articulation with the hamate. CONCLUSIONS: The results of this study showed that distal scaphoid resection produces a satisfactory clinical outcome, requires only a short period of immobilization, and should be considered one of the surgical options for long-standing scaphoid nonunion with either radioscaphoid or intercarpal degenerative arthritis. Nevertheless care must be taken in performing this procedure on patients whose preoperative radiograph show a type II lunate.

Adult↗
PubMed1996

Fractures and nonunions of the scaphoid.

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. Scaphoid nonunion often complicates scaphoid fractures especially if the diagnosis is missed initially, and adequate timely treatment is not provided. Displaced unstable fractures also have a tendency to develop nonunion. The tenuous vascular anatomy of the scaphoid, the inherent biomechanical instability of scaphoid fractures, and the difficulty of radiographic diagnosis are the culprits of nonunion. Established scaphoid nonunion is a challenging and difficult problem to treat and more so is the treatment of failed nonunion after grafting. New methods of diagnosis and treatment of scaphoid injuries are constantly evolving. One common method of treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Early diagnosis and attention to details of surgical technique are necessary for successful treatment outcome. The purpose of this report is to review the basic science, diagnosis, and treatment of scaphoid fractures and nonunions.

Adolescent↗
PubMed1997

The effects of exercise on ligamentous stiffness in the wrist.

The purpose of this study was to determine if exercise alters wrist joint laxity, as measured by the mechanical behavior of the scaphoid bone. The load-displacement behavior of the scaphoid was studied in the palmar-dorsal direction in both wrists of 7 healthy volunteers (n = 14) before and after 2 exercise protocols (grip and push-up). When compared to the rested values, both exercise protocols significantly increased the displacement at 40 N by 47% (grip) and by 34% (push-up). Accordingly, the stiffness decreased significantly by 36% (grip) and by 32% (push-up). Partial recovery was documented after 1 hour of rest and there were no differences between any of the groups after 24 hours of rest. The increase in laxity documented during these exercise protocols reduces the ligament loads at comparable wrist positions and may thereby reduce the likelihood of traumatic ligamentous injury during participation in strenuous activity or sports.

Adult↗
PubMed2001

Proximal row carpectomy for the treatment of scaphoid nonunion.

Nonunion of the scaphoid bone may occur even with early diagnosis of fracture and modern internal fixation techniques. A pattern of degenerative instability termed scaphoid nonunion advanced collapse may lead to collapse of the carpus with irreversible articular damage initially isolated to the radiostyloid joint. Proximal row carpectomy (PRC), which removes the intercalary proximal row and creates a radiocapitate articulation, is a motion preserving salvage procedure which unloads the areas of articular pathology, and creates a new articulation that allows motion and is able to bear compressive forces over time. Although results of PRC specifically for scaphoid nonunion are clearly not reported in the article, several studies demonstrate that PRC provides a pain relieving and motion-sparing salvage option particularly suited for this condition.

Carpal Bones↗
PubMedDate not supplied

Aseptic necrosis of the capitate bone in two gymnasts.

Aseptic necrosis of the capitate bone is a rare disease, except in the scaphoid bone and the lunate bone. This report describes an aseptic necrosis of the bone in two gymnasts. In both cases, the necrosis probably resulted from dorsiflexion compression injury in gymnastics. In an attempt to enable these patients to continue athletics, partial resection and drilling were performed to give successful results.

Adolescent↗
PubMed1989

[Diagnosis of unusual fractures of the wrist bones].

Fractures of the navicular bone are the most frequent fractures in the region of the wrist bone. Injuries of the other carpal bones are often primarily overlooked, since the examiner commands over less routine in diagnosing these rare fractures and the carpal bones are often superimposed over one another. We examined 9.723 x-ray films of the hand performed because of suspected fracture of the os naviculare, in order to find out how often lesions of the carpal bones - with the exception of those of the scaphoid bone - were discovered via the x-ray series of the os naviculare manus. For each individual wrist bone we recorded the incidence of fractures, clinical treatment and diagnoses, including any special x-ray takes that would be necessary for the detection of a particular fracture.

Carpal Bones↗
PubMed1991

A rare combination of fractures of the upper extremities: a diagnostic problem.

The rare case is reported of fractures concurrently of the bilateral proximal radius and the right proximal carpal row. Initial radiographs of the patient showed only fractures in the bilateral proximal radius and the right triquetral bone. In addition, the bone scan showed focal increased uptake in the right scaphoid bone and lunate bone as well, suggesting fractures. Fractures of the entire right proximal row were confirmed by computer tomography. The patient received functional treatment for the elbows and had a scaphoid plaster-of-Paris cast for the wrist. This resulted in a complete recovery after one year.

Adult↗
PubMed1980

Tendon interposition arthroplasty after resection of necrotic carpal bone.

Thirty seven patients with a necrotic lunate or a partially necrotic scaphoid bone underwent surgery. The necrotic bone was replaced with autologous tendons. The late follow-up examination showed good stability within the carpal skeleton and no progression of the osteoarthritis. The patients reported marked relief of symptoms and improved function of the wrist. Postoperative active motion and strength were only slightly impaired. Very few complications and a smooth professional rehabilitation characterize this surgical procedure.

Adolescent↗
PubMed2001

Scaphoid fractures: evaluation with high-spatial-resolution US initial results.

PURPOSE: To evaluate the diagnostic accuracy of high-spatial-resolution ultrasonography (US) in the diagnosis of scaphoid fractures. MATERIALS AND METHODS: In 72 hours after acute wrist trauma, 15 consecutive patients were examined for possible scaphoid fractures clinically and with conventional radiographs, including scaphoid views. Thereafter, high-spatial-resolution US was performed by two experienced radiologists blinded to the results of the previously performed investigations. High-spatial-resolution US of the scaphoid bones was performed from the palmar, lateral, and dorsal directions in the longitudinal and transverse planes. US findings indicative of a scaphoid fracture were cortical discontinuity and/or periosteal elevation. Finally, magnetic resonance (MR) images (short inversion time inversion-recovery, T1- and T2*-weighted) (ie, the standard) of the affected wrist were obtained and evaluated for a possible scaphoid fracture by two radiologists in consensus. RESULTS: Nine of 15 patients had scaphoid fractures. Seven (78%) of nine patients had positive findings at high-spatial-resolution US and five (56%) had such findings at conventional radiography (ie, four occult scaphoid fractures), with an accuracy of 87% and 73%, respectively. Two (50%) of four radiographically occult scaphoid fractures were depicted with high-spatial-resolution US. Sonographic findings of scaphoid fractures were either cortical discontinuity (n = 4), periosteal elevation (n = 2), or a combination of these two findings (n = 1). CONCLUSION: High-spatial-resolution US is a reliable diagnostic tool for the evaluation of occult scaphoid fractures and should be considered an adequate alternative diagnostic tool prior to computed tomography or MR imaging.

Adolescent↗