Simultaneous fracture of the carpal scaphoid and adjacent bones.
Eleven cases of simultaneous fracture of the carpal scaphoid and neighbouring bones are presented. The factors necessary for the occurrence of such injuries are discussed.
Adult↗
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[Changes in the wrist joint in spontaneous course of scaphoid pseudarthrosis].
Scaphoid non-union always leads to carpal arthrosis. What is the natural history and course and sequence of development of arthrosis in scaphoid bone pseudarthrosis and what factors play a role in this? Forty-nine patients with scaphoid non-union were followed up; the period of observation was between three and 39 years. For comparison, 55 patients in whom a Matti-Russe reconstruction had been carried out successfully in the same period were followed up. Both the clinical and the radiological appearance seemed to be better in the operated patients than in the unoperated patients. The time factor, the position and form of the fracture appeared to be crucial for the development of arthrosis. No patient was free of arthrosis after ten years. The arthrosis begins in the radial part of the radiocarpal joint and progresses to the mediocarpal joint. The development of mediocarpal arthrosis takes about 20 years. Unstable and displaced fractures accelerate the development of arthrosis. Proximally located non-unions are unfavorable because of the danger of osteonecrosis of the proximal fragment. These non-unions should be treated surgically as soon as possible.
Adolescent↗
The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions.
PURPOSE: Over the past decade vascularized bone grafts that use a 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) pedicle have gained popularity in the treatment of scaphoid nonunions. The purpose of this study was to evaluate critically the outcome, complications, and failures of 1,2-ICSRA-based vascularized bone grafting at our institution to understand better the appropriate indications, methods, and possible contraindications. METHODS: From January 1994 through July 2003, 50 scaphoid nonunions in 49 patients were treated with 1,2-ICSRA-based vascularized bone grafts. A retrospective review of the clinical and radiographic information was performed. Two patients were lost to follow-up study. Nine female and 38 male patients averaging 24 years of age were followed-up for an average of 7.8 months. RESULTS: Thirty-four scaphoid nonunions went on to union at an average of 15.6 weeks after surgery. Complications occurred in 8 patients and consisted of graft extrusion, superficial infection, deep infection, and failure of fixation. Univariate risk factors for failure included older age, proximal pole avascular necrosis, preoperative humpback deformity, nonscrew fixation, tobacco use, and female gender. CONCLUSIONS: Although previous researchers have concluded that vascularized bone grafts based on the 1,2-ICSRA are efficacious in the treatment of scaphoid nonunions, we determined that a successful outcome is not universal and depends on careful patient and fracture selection and appropriate surgical techniques. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
Adolescent↗
Movement of the scaphoid in the normal wrist.
The radiological images of 30 normal wrists in varying degrees of radial and ulnar deviation were analysed by measuring parameters of flexion and translation of the scaphoid bone. Results demonstrated a linear relationship, indicating that movement is consistently either by flexion of the scaphoid, translation or more commonly a combination of the two. The significance of this is discussed. There did not appear to be any age or sex related differences.
Adult↗
[Intra-osseous ganglion of scaphoid and lunate bones].
We present a patient with intra-osseous ganglion of the left scaphoid and lunate bones. These were excised and a bone graft inserted. 1 year after operation the patient was free of pain, without limitation of wrist motion. Intra-osseous ganglion of the carpal bone is not common and lunate and scaphoid intra-osseous ganglion has rarely been reported. Awareness of this condition may lead to earlier diagnosis and treatment, with satisfactory outcome.
Adult↗
Small joint fusions of the hand using the Herbert Bone Screw.
The Herbert Bone Screw has a thread at both ends and was originally developed for internal fixation of fractured scaphoid bones. The two main advantages of compression and no head, make it most suitable for internal splinting of the small joints of the hand. The authors have used this device on thirty-nine joints in ten different sites of the hand, and it has proved to be an extremely successful method.
Arthrodesis↗
Non-union fractures of the scaphoid and carpal bones in children: surgical treatment.
Carpal bone fractures in children are rare. This study reports a series of 16 cases: 12 fractures of the scaphoid (11 non-union), two of the trapezium, one (non-union) of the hamatum, and one of the triquetrum. Only three of these fractures (triquetrum, trapezium and hamatum) were seen at an early stage. The non-union cases involving the scaphoid and hamatum were treated by bone graft. The scaphoid fracture seen early and the triquetrum fracture were treated orthopaedically. One trapezium fracture was treated by osteosynthesis with wires, and the other (seen at the defective callus stage) was not treated because of a total absence of symptomatology. All fractures or non-union cases consolidated. After a minimum follow-up of 1 year, all patients except one have regained strength and mobility comparable to that of the contralateral limb, with a near total absence of pain. Only the patient with an articular fracture of the trapezium has lost 30% of strength compared with the uninjured limb.
Adolescent↗
[Diagnosis of carpal bone fractures].
The diagnosis of carpal bone fractures has been facilitated by new radiological projections and by the advent of modern imaging methods. Fractures of the scaphoid bone still account for 75% of carpal fractures with their complications (pseudarthrosis, malunion) and their sequelae of arthrosis. However, the frequency of other fractures appears to be increasing due to a better knowledge of their mechanism and to the possibilities of the new imaging methods.
Carpal Bones↗
Bilateral intraosseous ganglia of the scaphoid and lunate bones.
A rare case of simultaneous bilateral intraosseous ganglia of the scaphoid and lunate bones is presented. The cysts were removed and the carpal bones were grafted with cancellous bone, resulting in a satisfactory outcome.
Adult↗
The fate of failed bone graft surgery for scaphoid nonunions.
Twenty patients with scaphoid nonunions had bone grafting procedures that failed to achieve union. Nineteen had persistent wrist pain. Electrical stimulation after bone grafting proved useless in obtaining union in five patients. Sixteen patients had additional surgery. Ten had repeat bone grafting. Six scaphoids united after a second grafting and one united after a third graft. However, at follow-up only three of these seven patients had no pain in their wrists. The rate of union was not affected by fracture location, the presence of proximal pole avascular necrosis, or instability. The three patients with nonunion after two bone grafts remain symptomatic. Six patients had salvage procedures; silicone replacement arthroplasty (3), wrist fusion (1), proximal pole excision (1), intercarpal fusion (1). Four were asymptomatic after one of these procedures and two (silicone arthroplasty and intercarpal fusion) became asymptomatic after wrist fusions. Five fractures, believed to be united on the basis of plain radiographs, later demonstrated persistent nonunions. We recommend adequate radiologic follow-up, including tomography, to determine whether or not fracture union has occurred.
Bone Transplantation↗
Idiopathic necrosis of the capitate.
Avascular necrosis of the capitate bone in a 38-year-old man is presented. The patient was treated by intercarpal fusion of the capitate, lunate and scaphoid bone to relieve pain.
Adult↗
Scaphoid fracture: a new method of assessment.
The value of colour flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture has been examined. A prospective study of 78 patients with signs and symptoms of carpal scaphoid injury was undertaken over a period of 6 months. Both wrists of all patients were scanned within 12-72 h of injury. The radial artery and carpal scaphoid bone contours are visible using this type of imaging technique. The distance between the medial wall of the radial artery and the outer cortex of the scaphoid waist was measured. The scaphoid index is described and was calculated from this measurement. Patients were managed without knowledge of the ultrasound imaging result, using plain radiographs and clinical examination as the standard for determining the presence of a scaphoid fracture. All patients were followed to the resolution of symptoms. All 12 patients who were subsequently considered to have scaphoid fractures were identified using this imaging technique within 12-72 h after injury. We conclude that this imaging may be useful in the assessment of patients with carpal scaphoid fracture. It can be used early, as a supplementary investigation, in patients with suspected carpal scaphoid fracture in whom the initial plain radiographs are normal.
Adolescent↗
Occurrence of carpal osteoarthritis after treatment of scaphoid nonunion with bone graft and herbert screw: a long-term follow-up study.
PURPOSE: To determine the occurrence, progression, and clinical results of osteoarthritis (OA) after bone grafting and Herbert screw fixation for scaphoid nonunion. METHODS: Fifty patients were reviewed (mean follow-up period, 12.0 +/- 1.6 y) to analyze degenerative changes of the wrist after use of Herbert screws for scaphoid nonunion. RESULTS: Radiologic signs of OA were observed in 15 of 50 patients before surgery and in 23 of 50 after 10 years or more. The majority of degenerative changes were low grade. No OA at follow-up evaluation was seen in 27 of 35 patients with no preoperative degenerative changes. In 6 of 8 patients with OA its occurrence was either subsequent to concomitant injury, occurred after incorrect scaphoid reconstruction, or was caused by persistent nonunion. Of 15 wrists with OA at the time of surgery 9 remained unchanged and 6 increased in severity. Healing of nonunion was achieved in 42 of 50. Range of motion, however, was reduced to 88% of that of the opposite hand. At follow-up evaluation the mean Disabilities of the Arm, Shoulder, and Hand score was 9 +/- 13 and the mean Cooney score was 80 +/- 10. CONCLUSIONS: The results show high patient satisfaction and good function after healing of scaphoid nonunion. In the long term correct anatomic reconstruction of the nonarthritic carpus with a Herbert screw prevents onset of OA in most patients.
Adolescent↗
The dorsal arterial network of the wrist with reference to the blood supply of the carpal bones.
The gross examination of 50 minium injected specimens showed us the various patterns of the posterior arterial network of the wrist. This is chiefly provided by the radial artery which gives off a constant dorsal carpal branch over the posterior aspect of the trapezium. This vessel crosses the carpus transversely to the inner border of the hand and is joined in half of the cases by the interosseous artery; contribution of the posterior carpal branch of the ulnar artery was more rarely found than usually described (25%). From the arch thus formed are given off short branches which run upwards along the intercarpal joints and enter the posterior aspects of the proximal carpal bones whose lower halves seem to be the most favorably supplied. On the contrary, the distal carpal bones receive several short twigs which penetrate their posterior surfaces. Although the arrangement of the pedicles may undergo many a variation, attention must be drawn to the fact that the dorsal arteries are smaller but denser than the volar, except for the hamate. Therefore 2 different patterns of arterial supply can be described at the carpus: the blood supply of the outer and axial bones--scaphoid, trapezium, lunate, capitate--derives from the radial and the interosseous arteries and is probably shared equally by volar and dorsal branches; the inner bones--triquetrum, hamate--are primarily supplied by volar or medial branches coming almost exclusively from the ulnar artery.
Adult↗
Osteoid osteomas of the hand. Report of three cases and review of the literature.
Osteoid osteoma is infrequently localized to the hand. Initially the lesion causes unspecific symptoms, and the radiographic changes are discrete. Three cases were seen during a period of 5 years. Bone scintigraphy was a useful diagnostic tool, and CT facilitated the identification of the nidus. One of the lesions was a double nidus osteoid osteoma of the scaphoid bone. Only 12 instances of multifocal osteoid osteomas have been reported, none of which was localized to the carpal bones.
Adolescent↗
Regional scintimetry in scaphoid fractures.
A quantitative scintigraphic method was introduced to examine the proximal, middle and distal third of the carpal scaphoid bone. 99mTc-Sn-pyrophosphate scintimetry was obtained by the use of a gamma camera equipped with a pinhole collimator. Of six patients in whom a unilateral fresh fracture of the scaphoid was clinically suspected, radiology showed a fracture of the scaphoid in four and no fractures in two. The method may be suitable in early diagnosis and further localization of clinically suspected fractures with initially non-diagnostic radiographs.
Adolescent↗
Suspected scaphoid fractures. Can we avoid overkill?
Among 231 patients with clinical signs of a fractured carpal scaphoid but negative primary radiographs, only 3 fractures of the scaphoid were finally diagnosed on subsequent radiological and clinical examinations. Two of these could be seen retrospectively in the primary radiographs. After an observation period of two to three weeks in dorsal plaster casts, 88.8% of the patients were discharged from the outpatient department as having soft-tissue injuries. They required no further treatment. This "overkill" is unsatisfactory, as we agree with other studies that almost 100% of factual fractures of the scaphoid bone are visible on initial radiographs of good quality, using 4 or 5 different views and evaluated by a senior radiologist. We propose a more stringent clinical inclusion into the category of "clinical scaphoid fracture" and the use of simple supportive bandages in an observation period.
Adolescent↗
An experimental study of instability during supination and pronation of the fractured scaphoid.
Rotatory instability of scaphoid fractures was studied by a method not used previously. On two fresh specimens the scaphoid bone was fractured by osteotomy, and the fracture was fixed by a Hoffmann apparatus extending from the distal radius to the 1st, 2nd and 3rd metacarpals. This permits free rotation in the forearm. The scaphoid fragments were marked by Kirschner wires. No movement occurred between the fragments when supination/pronation was kept within the normal range of movement.
Cadaver↗