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PubMed2001

Percutaneous fixation of scaphoid fractures.

The scaphoid proximal pole and waist fractures presented here were treated by a novel dorsal percutaneous technique with arthroscopic assistance. All fractures healed, with good final functional results and no complications. The advantages of the dorsal percutaneous approach to scaphoid fixation are: (1) the proximal-to-distal placement of the guide pin and screw allow for more precise placement along the central axis of the scaphoid, which decreases healing time and reduces risk of screw thread exposure. (2) The dorsal approach avoids injuring the vulnerable volar ligament anatomy. And (3) the insertion of the screw from the proximal to distal direction allows the more rigid fixation of proximal scaphoid fractures. Arthroscopy allows confirmation of fracture reduction and screw implantation as well as evaluation of concurrent ligament injuries not detected with standard imaging. Percutaneous K-wires act as joysticks to reduce and compress fracture fragments prior to fixation. The presented technique allows for early, rigid internal fixation with minimal associated morbidity. Patients successfully treated with this technique include those with stable and unstable acute fractures of the scaphoid at all locations, including the proximal pole. Nondisplaced fractures that present with delayed or fibrous union without evidence of avascular necrosis, cyst formation, or bony sclerosis may also be treated with this technique. This technique allows for faster rehabilitation and an earlier return to work or avocation without restriction once CT scan confirms a solid union. Some articles document extraordinary rapid healing by standard radiographs; however, we caution that scaphoid bone healing cannot accurately be determined without CT scan. Percutaneous, arthroscopically assisted internal fixation by a dorsal approach may be considered in all acute scaphoid fractures selected for surgical fixation. The dorsal guidewire permits dorsal and volar implantation of a cannulated screw along the central axis of the scaphoid. This technique permits the reduction of displaced fractures and the stable repair of fractures of the proximal pole. In addition, selected scaphoid fibrous union or delayed union may also be repaired, with realistic expectations of healing. The proven benefits of the percutaneous technique include decreased soft tissue trauma; arthroscopic visualization of the fracture, ensuring anatomic reduction; and stable fixation, allowing early physical rehabilitation. The theoretical benefits of the technique include decreased risk of interruption of the tenuous scaphoid blood supply. Percutaneous internal fixation of scaphoid fractures provides faster rehabilitation, earlier return to work, and quicker bony union in most patients.

Arthroscopy↗
PubMed1995

Scaphoid fractures and nonunions.

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. 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. The treatment of established scaphoid nonunion is difficult, and more so is the treatment of failed nonunion after grafting. One common method for treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Attention to details of surgical technique are necessary for successful treatment outcome.

Adolescent↗
PubMed2001

[Unilateral congenital aplasia of the scaphoid and dysplasia of the trapezium (a case report)].

Aplasia of the carpal scaphoid bone in association with dysplasia of the trapezium is a rare disorder. A right-handed, 66 years old male, suffering from a trapeziometacarpal arthritis on the right side is reported. X rays, MRI and CT-scan reveal an absence of scaphoid and a dysplasia of the trapezium. The lunate remains in place on the radius but is oriented in dorsi flexion. The capitate is dorsally and radially subluxated. Trapezium inclination of the joint at the base of the first metacarpal (trapezial tilt) is 32 degrees greater than on the opposite side which is normal (48 degrees). Radial styloid is hypoplasic. The scaphoid fossa is not covered with cartilage and subchondral sclerotic bone. The intercarpal joints show no trace of arthritis. There are no other deformation on the radial segment of the hand and the forearm. This congenital absence of scaphoid remains asymptomatic and well tolerated excepting the dysplasic trapeziometacarpal joint.

Aged↗
PubMed1990

[Fresh fractures! Classification, management, results and problems: the wrist joint].

Carpal bone fractures are rare, with an incidence of 13% compared to that of fractures and luxations of the hand bones. Generally they are intraarticular fractures. Fracture of the scaphoid bone occurs most frequently, with an incidence of 75%. The greater number of fractures is found in the middle-third of the wrist bordering on the os lunatum. They are usually treated conservatively by splinting with a cast. Surgery is indicated only when the fracture is open, instable, dislocated or combined with carpal instabilities.

Carpal Bones↗
PubMed1997

[Luno-triquetral angle and dislocation of the wrist].

The mediocarpal force, determined by the distal articular surface of both, lunate and triquetral bones, abuts against the double bolt, composed of the scaphoid and the radial styloid process. An important wrist trauma can rupture this bolt and cause a proximal and lateral translation of the distal carpal row. This situation may present under 3 forms: fracture of the scaphoid bone and midcarpal dissociation; fracture of the radial styloid process with scapholunate dissociation; scapholunate dissociation, associated with a dorsal radiotriquetral ligament rupture and medial translation of the lunotriquetral block. Experimental and clinical illustration of this process, discussion and treatment.

Carpal Bones↗
PubMed2005

Patterns of bone defect in scaphoid nonunion: a 3-dimensional and quantitative analysis.

PURPOSE: To clarify patterns and size of bone defect in scaphoid nonunion in order to facilitate accurate correction of scaphoid deformity. METHODS: Three-dimensional computed tomography was used to examine 24 patients with scaphoid nonunion. Configuration and size of bone defect were quantified and computed on the basis of fracture location. Cases were categorized as distal or proximal based on location of the fracture line relative to the dorsal apex of the scaphoid ridge. RESULTS: Distal scaphoid fractures displayed wedge-shaped bone defects with the base facing volarly. Proximal scaphoid fractures exhibited flat, crescent-shaped defects that presented only around the fracture site. The size of bone defects was significantly greater for distal fractures than for proximal fractures. CONCLUSIONS: Whether the fracture line passes distal or proximal to the dorsal apex of the scaphoid ridge is a crucial factor in the generation of bone defect. A large wedge-shaped bone graft from the volar side is necessary for distal nonunion whereas a small cancellous bone graft from the dorsal side may be preferable for proximal nonunion.

Adolescent↗
PubMed1999

Effect of bone quality on the forces generated by compression screws.

Internal fixation of the fractured scaphoid bone is used to promote union between bone fragments and to decrease wrist immobilization. Headless screws are commonly used because they minimize interference with articular surfaces and reduce tissue irritation and immobilization. In the present experiment, compressive force was measured as a function of bone quality for two headless screw types, the Herbert and the Acutrak. Forty-seven cylindrical samples of cancellous bone were prepared from fresh, previously frozen human cadaveric distal femora. The compressive forces generated as the screws were advanced into the specimens were measured and correlated to the specimens' bone mineral density (BMD) and density. Over the range tested, the average compressive force for the Acutrack screw was approximately 42% higher than that of the Herbert. Statistical significance, however, could not established because of the low statistical power of the test due to the inherent spread in the data. For the Acutrak screw, force was best fit to BMD and to density by second-order polynomials. Regression analysis indicated that similar correlations did not exist between force and BMD or between force and density for the Herbert screw. The correlation shown by the Acutrak screw indicates that it may be a more predictable as well as more effective system and therefore there may be some advantage in selecting this system. Furthermore, results suggest that the Acutrak screw generates greater forces with increasing bone density and could be more effective for a younger population.

Biomechanical Phenomena↗
PubMed2001

Review of the current methods in the diagnosis and treatment of scaphoid fractures.

If neglected or misdiagnosed, non-union of a scaphoid fracture will almost inevitably progress to radiographic and symptomatic osteoarthritis of the wrist with subsequent morbidity and lifelong disability, especially in young males in which the fracture is more common. Fractures of the scaphoid bone are the most common fractures of the carpus and second in occurrence among fractures of the wrist. The diagnosis and treatment are not simple. Familiarity with different imaging methods and treatment options is required. The treatment in most cases is conservative and will lead to uneventful union, but an operation may be needed in certain cases primarily and in the treatment of non-union. The current literature on the diagnosis and treatment of scaphoid fractures is reviewed, and the authors try to make a clear and concise picture of this complex and sometimes controversial field.

Casts, Surgical↗
PubMed1989

[Stress on the normal and pathologic wrist joint].

The wrist joint is generally stressed by external forces. The resultant of these external forces produces the pressure in the joint which evokes pressure stresses within the supporting tissues of the joint. As was shown by Pauwels (1973) the density of the subchondral bone is adapted to articular stress distribution. The zone of subchondral bone can be seen as the morphological equivalent of the specific joint stress. This paper shows by means of density analyses and pressure measurements that in contrast to earlier opinions joint pressure is transmitted both by the lunate and the scaphoid bones. It seems that the physiological stress is even higher in the scaphoid than in the lunate bone. The force transmission between the lunate and the ulnar disc is less pronounced. The analysis of the lunatal trabecular architecture leads to the suggestion that the lunate is stressed differentially in the radio-ulnar plane. In pathological conditions of the wrist joint (perforation of the disc, ulnar shift, Kienböck's disease, ulna minus variant) the pressure and the density distribution are adapted to the pathomorphology in each case.

Aged↗
PubMed1999

[Automated system of bone maturity evaluation applied to the Tanner-Whitehouse 2 method].

OBJECTIVE: Employing automated methods of image analysis to determine bone maturity helps to avoid subjectivity, reduce the execution time and to increase continuity in maturity scales. We have studied bone maturity by the Tanner-Whitehouse method (TW2) and by image analysis based on Fourier transformation. PATIENTS AND METHODS: Bone maturity (BM) was evaluated in 200 X-rays of the left hand and wrist from 45 children between 2 and 18 years of age employing the TW2 method, manual or traditional, to determine the state of maturity of each bone. At the same time, BM was evaluated by using an automated form of a recognizance program (IMAGO 2). As a standard we used the schemes of the phases described in the TW2 method. The image of the bone in question captured by a video camera after digitalization was classified by statistical comparison of its Fourier coefficient matrix with that previously determined by each of the standard schemes. Manual and computerized bone age concordance was also studied. RESULTS: The computerized procedure showed a tendency to give lower values than the manual procedure. There were no significant differences between mean phases when calculated by both methods (manual and computerized) for the radius and the fifth metacarpal. The least degree of concordance was observed in the third metacarpal and phalanges. We found better concordance in the carpal bones than in the phalanges. This concordance was lower than that found in the radius and fifth metacarpal. The worst results were observed in the carpus and large bones and the best results were observed in the semilunar and scaphoid bones. CONCLUSIONS: Divergence in the reproducibility between this computerized system and others (CASES method) are probably related to the differences between the digitalization process and the standard images used.

Adolescent↗
PubMedDate not supplied

Technique for diagnosis of scaphoid fractures.

Fracture of the scaphoid bone accounts for 60 percent of all carpal injuries. Early diagnosis of a scaphoid fracture is extremely important. Missing the fracture may lead to disability due to potential avascular necrosis or non-union of the fragments. The presence of a scaphoid fracture may be determined with greater certainty by using a multiple angle scaphoid series detailed by the author.

Adult↗
PubMed1998

Bilateral congenital aplasia of the scaphoid.

A case of bilateral congenital aplasia of the carpal scaphoid bone is presented. In contrast to previously reported cases of congenital hypoplasia of the scaphoid, this case was not associated with hypoplasia or absence of thenar and forearm muscles, absence of the sesamoid bones of the thumb, abnormalities of the skeleton of the thumb ray or hypoplasia of the forearm bones.

Adult↗
PubMedDate not supplied

The use of vascularized grafts from the distal radius for the treatment of Preiser's disease.

PURPOSE: To examine the outcome of vascularized bone grafts (VBGs) used for the treatment of Preiser's disease. METHODS: Over a 10-year period (1993-2003) 8 pedicled VBGs were performed as the primary treatment for Preiser's disease. All patients had preoperative magnetic resonance imaging (MRI) scans that confirmed the diagnosis of avascular necrosis of the scaphoid. Bone revascularization was evaluated by examining preoperative and postoperative MRIs. All patients had a reverse-flow pedicled VBG from the distal radius. The average patient age was 40 years and the mean follow-up period was 36 months. Postoperative evaluation included range of motion, grip strength, pain evaluation, and Mayo wrist scores. RESULTS: All MRIs showed evidence of revascularization, with improvement in T2 and/or T1 signal; however, a consistent finding on MRI was incomplete revascularization of the entire proximal pole. Wrist motion averaged 55% of the unaffected side after surgery. Grip strength remained stable. Seven patients had long-term improvement in pain. The average Mayo wrist score was 68, with 1 patient rated as excellent, 1 as good, 5 as fair, and 1 as poor. There was 1 reconstructive failure that resulted in a proximal row carpectomy less than 1 year after the surgery. CONCLUSIONS: In this series VBGs led to reduced pain levels and preserved the radiocarpal wrist motion in most patients. Inability to revascularize the proximal pole of the scaphoid and ongoing wrist arthritis appear to persist despite revascularization attempts. VBGs for Preiser's disease should be limited to patients with early stage disease (Herbert stages I or II) without evidence of radiocarpal arthritis and no evidence of carpal instability. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adult↗
PubMed1985

The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion.

This article reports a prospective study of 45 patients with nonunion of the scaphoid treated with Russe bone grafting. The operative procedure contains modifications in the technique made by Russe subsequent to his 1960 article. The results strongly support Russe's contention that his operation is not likely to be successful if the proximal pole is totally avascular. Twenty-four (92%) of 26 patients with good vascularity in the proximal pole achieved solid union. In patients in whom the vascularity of the proximal pole was spotty or diminished, the rate of union dropped to 71% (10 of 14). Most important, none of the five patients in whom the proximal pole was totally avascular achieved successful union. True avascular necrosis is best determined by punctate bleeding points in cancellous bone found at operation, and cannot be accurately predicted by the appearance of preoperative radiographs.

Adolescent↗
PubMed1980

A peculiar variation of the musculature of the front of the forearm.

On the front of the right forearm of an adult male individual a hitherto undescribed supernumerary muscle was observed. This fusiform muscle originated from the lateral aspect of the coronoid process of the ulna and the lateral margin of the radius, distal to the attachment of the supinator muscle, and inserted - through the intermediary of an aponeurotic structure enveloping the synovial sheaths of the flexor digitorum superficialis and profundus and flexor pollicis longus muscles as well as of the extensor pollicis brevis and abductor pollicis longus muscles - to the pisiform bone, the pisohamate ligament and the tubercles of the trapezium and the scaphoid bone. It is argued that the muscle belongs to the group of the deep flexor muscles.

Adult↗
PubMed2004

Panoramic versus conventional radiography of scaphoid fractures.

OBJECTIVE: The objective of this study was to compare the diagnostic value of panoramic and conventional radiography in the detection of fractures of the carpal scaphoid bone. MATERIALS AND METHODS: Panoramic (orthopantomographic) and conventional radiographs of 90 patients with acute or chronic wrist trauma were reviewed retrospectively. Images were analyzed and reviewed independently by four observers: two radiologists and two traumatologists. The kappa statistic was used to calculate intraand interobserver agreement and the correlation between the two imaging techniques. RESULTS: Panoramic radiography of the wrist was superior to conventional radiography in ruling out scaphoid fractures (74%, 20/27) in patients with suspicious findings on conventional radiography; revealed more cases of scaphoid fractures (21.4%, 12/56); and revealed more cases of delayed union (n = 2), nonunion (n = 3), and union (n = 3). Agreement values were higher, with better inter- and intraobserver agreement, for the panoramic examinations than for the conventional radiographic examinations. CONCLUSION: The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings.

Adolescent↗
PubMed1989

Late treatment of scaphoid fractures by bone grafting and compression staple osteosynthesis.

Scaphoid nonunions and delayed unions still offer a difficult challenge. In 15 of 16 cases it was possible to achieve a secure and lasting union by using a compression staple and a bone graft. The subjective and objective clinical evaluation also showed similar favorable results. This modification of the Russe operation is recommended as a relatively simple procedure with good results and minimal need for immobilization.

Adult↗
PubMed2006

The effect of ultrasound on the healing of muscle-pediculated bone graft in scaphoid non-union.

The use of pedicled vascularised bone grafts from the distal radius makes it possible to transfer bone with a preserved circulation and viable osteoclasts and osteoblasts. Experiments performed at the basic science level has provided substantial evidence that low-intensity ultrasound can accelerate and augment the fracture healing process. Only an adequate double-blind trial comparing treatment by ultrasound stimulation in patients treated by similar surgical techniques can provide evidence of the true effect of ultrasound. This paper describes the results of such a trial. From 1999 to 2004, 21 fractures of the scaphoid with established non-union treated with vascularised pedicle bone graft were selected for inclusion in a double-blind trial. All patients were males, with an average age of 26.7 years (range 17-42 years) and an average interval between injury and surgery of 38.4 months (range 3 months-10 years). Low-intensity ultrasound was delivered using a TheraMed 101-B bone-growth stimulator (30 mW/cm2, 20 min/day), which was modified to accomplish double-blinding. These modifications did not affect the designated active units. The placebo units were adjusted to give no ultrasound signal output across the transducer. Externally, all units appeared identical but were marked with individual code numbers. Patients were randomly allocated to either an active or placebo stimulation. Follow-up averaged 2.3 years (range 1-4 years). All patients achieved fracture union (active and placebo groups), but compared with the placebo device (11 patients), the active device (ten patients) accelerated healing by 38 days (56+/-3.2 days compared with 94+/-4.8 days, p<0.0001, analysis of variance).

Adolescent↗