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At least 379 records · Page 21Linked to original sources
PubMed2003

Vascularized second metacarpal-base bone graft in scaphoid non-union by the palmar approach.

Vascularized second metacarpal-base bone grafting from the palmar side for scaphoid non-union was performed in seven patients (six males and one female, with a mean age of 26 years). In all patients, bone union was obtained at a mean of 10.2 weeks. In six of the seven patients, preoperative dorsal intercalated segment instability (DISI) was corrected. The results were excellent in three patients, good in two patients, and fair in two patients, showing that more than 80 percent of the patients had satisfactory results. In this procedure, the second dorsal metacarpal artery, with a large vascular diameter, is used as the pedicle, and the second metacarpal base, which is abundant in cancellous bone, is elevated on the dorsal side and grafted on the open-wedged scaphoid non-union on the palmar side. This procedure is reliable and useful, particularly for scaphoid non-union with DISI.

Adolescent↗
PubMed1998

[Embryology of the human carpal bones (triangular cartilage, central carpal bone, morphogenesis of the scaphoid)].

Wax reconstructions according to Born's methods were performed from serial 10-micron sections of the wrists of human embryos (B. Tardif) to study the triangular cartilage and central bone of the carpus. A subsequent morphological study of the adult scaphoid bone was conducted in the light of embryological data. The triangular cartilage was observed in 4 of 38 carpi of embryos with a craniocaudal length of 40 to 69 mm, flatten between the ulna and triquetrum, on the inferior surface of the mesenchymal bud of the triangular ligament. The central bone of the carpus is constant in the embryo, between the inferior surface of the radial chondrification centre, capitatum, trapezium and trapezoid. In one case, the two wrists of the same embryo presented two central nuclei, leading to the distinction of two different formations:--the constant C2 embryonic central bone, trapped between capitatum, trapezoid and trapezium, which participates in the constitution of the scaphoid by fusion with the radial chondrification centre;--the C1 central bone, a rare supernumerary bone in adults, close to the inferolateral angle of the lunatum, on the dorsal surface of the carpus. These embryological data support. Westoll's theory concerning the filiation of the thoracic limb since the fin of crossopterygians, with deviation of the mechanical axis related to the development of weightbearing on the ground. The scaphoid bone must to be assimilated to a cube, but to an irregular tetrahedron, composed of two inverted pyramids joined by their bases. The inferior pyramid, articulating with he trapezium, trapezoid and capitatum, is concerned by morphological variations of the bone, which can present variable configurations between the two extreme morphotypes: the massive type and the strangulated type. The inferior pyramid, constituting the scaphoid, is derived from the central cartilage and presents the same relations. Variations of the volume of this inferior part of the bone are related to the more or less marked regression of this chondrification centre of the embryonic carpus. These variations of the bone can be expressed in terms of a scaphoid index, by calculating the relationship between the greatest dimension and the width of the narrowed portion.

Adult↗
PubMed1996

Magnetic resonance imaging of occult scaphoid fractures.

Occult fractures of the scaphoid bone occur frequently and may lead to nonunions. In a prospective blind study, we performed magnetic resonance imaging (MRI) examinations on 32 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected, but could not be confirmed on the original set of two routine and four scaphoid view radiographs. The MRI examinations were performed an average time of 2.8 days after the trauma. This prospective study proved that MRI is able to diagnose occult scaphoid fractures without delay and without the use of radioactive diagnostic means. Sensitivity and specificity of MRI were 100%. This conventional method could save $7,200 (US) per 100,000 inhabitants in providing an immediate and correct diagnosis and avoiding unnecessary cast immobilization. Additional injuries that may be misdiagnosed by conventional radiographs are also detected with a specificity and sensitivity of 100%.

Adolescent↗
PubMed1989

[The effect of inactivity-induced osteoporosis on the scintigraphic image of bone lesions of the wrist].

In addition to its established oncological indications the sensitivity of bone scintigraphy is of steadily increasing significance in traumatology. Inactivity-induced osteoporosis plays a major role during the immobilization period in the plaster cast. In the region of the joints remodelling intensity may reach such a high level that the non-injured bone shows a higher rate of accumulation than the fracture. This process already begins between the third and fourth week of immobilization. The highest uptake is found after fracture of the scaphoid bone at the end of twelve weeks of immobilization. Control scintigraphies at intervals of several days are indicated to differentiate between various clinical conditions (pseudoarthrosis, activated osteoarthrosis, algodystrophy in case of doubtful x-ray results).

Carpal Bones↗
PubMed1991

Biomechanical comparison of fixation devices in experimental scaphoid osteotomies.

This study determined the force, bending rigidity, and bending moment at failure of three types of internal fixation systems for the scaphoid bone. A pair of parallel, 0.045-inch Kirschner wires were compared on a paired, bilateral basis with either a Herbert screw or a 3.5 millimeter cannulated screw in repairing a transverse waist osteotomy in cadaver scaphoids. The mean values at failure of the Herbert screw and the cannulated screw versus the paired, parallel Kirschner wires for force (65 N and 77 N versus 23.7 N), rigidity (0.47 Nm2 and 0.54 Nm2 versus 0.16 Nm2) and bending (0.98 Nm and 1.15 Nm versus 0.36 Nm) were approximately three times greater. These differences were statistically significant when compared on a paired basis. This experiment demonstrates that the Herbert screw and cannulated screw are significantly stronger in resisting bending forces than paired, parallel Kirschner wires.

Biomechanical Phenomena↗
PubMed1982

Fractures and pseudarthrosis of the carpal scaphoid.

The ultimate outcome of fractures of the scaphoid bone is determined by the choice of initial treatment. The special characteristics of the blood supply to the bone, which often increase the risk of non-union, have prompted us to propose the indications for primary surgical treatment based on the radiographic appearances. The authors propose a classification of the radiographic characteristics of fractures of the scaphoid for determining at the outset the treatment most likely to achieve consolidation and hence a more rapid resumption of occupational and sports activities. They present the results obtained in the treatment of 101 recent fractures of the scaphoid, eighty-one of which they were able to follow up after at least one year. In cases of established pseudarthrosis of the scaphoid they propose a pedicled transplant technique as conforming better to the anatomical, morphological and functional pre-requisites of the operation. The results obtained in the treatment of twenty-nine cases of pseudarthrosis are presented. The case material relates to patients treated at the G. Pini Orthopaedic Institute of Milan and, in the case of sportsmen, at the Centre for sports injuries of the same institute.

Carpal Bones↗
PubMed1981

[Treatment outcome in de Quervain's dislocation fracture].

In De Quervains dislocation fracture pseudarthroses of the scaphoid bone following closed reduction are very common, 59% being reported in a former publication. Exact adaptation of the fragments after reduction of the perilunar dislocation is essential for healing of the fracture. In cases where this is not possible by conservative means, open reduction and screwing of the scaphoid fracture is necessary for better result with a rate of pseudarthroses of only 16%.

Bone Screws↗
PubMed2001

Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay.

This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement.

Arthritis, Rheumatoid↗
PubMed1988

Treatment of scaphoid fractures with a removable cast.

Forty-four fractures of the scaphoid bone were treated with a short-term removable orthoplast cast and compared with 48 fractures treated with a conventional long-arm plaster cast. At the follow-up, there was no difference between the two treatment groups as regards nonunion or other sequelae. We conclude that the inconvenience of the treatment of scaphoid fracture and the need of physiotherapy can be reduced by using an orthoplast cast.

Carpal Bones↗
PubMed2005

Outcome of routine bone scintigraphy in suspected scaphoid fractures.

UNLABELLED: Undisplaced scaphoid fractures are easily missed on conventional scaphoid radiographs, but these occult fractures may seriously impair hand function. Routine bone scintigraphy (BS) is often advocated if there are clinical signs of a scaphoid fracture without radiological evidence. However, the results require careful therapeutic management. OBJECTIVE: To determine the diagnostic value of BS in daily practice for clinically suspected scaphoid fractures. METHODS: We evaluated our protocol of routine BS in suspected scaphoid fractures. SUBJECTS: In a retrospective study, we analysed 111 consecutive cases with signs of a scaphoid fracture on physical examination. Radiographs revealed 55 fractures, the remaining 56 patients all underwent BS. MAIN RESULTS: On average, the BS was performed after 4 days. It showed a fracture in 38/56 of the patients. The distribution of fractures was: scaphoid bone 15, distal radius 11, other carpal bones 9 and metacarpal bones 3. CONCLUSION: If there is a strong clinical suspicion of a scaphoid fracture, which cannot be confirmed by conventional radiology, BS is a valuable diagnostic tool.

Adolescent↗
PubMed1988

Technical factors related to Herbert screw fixation.

We reviewed 24 patients treated for an acute fracture or a nonunion of the scaphoid bone using the Herbert screw. Mean follow-up in 22 patients who returned for examination was 17 months. The overall union rate was 67% for both acute fractures and nonunions. Fracture healing correlated strongly with technical factors of the procedure. The fracture failed to heal in seven of nine cases with poor scaphoid realignment, inaccurate jig placement, or improper screw length for a nonunion rate of 78%. Conversely, without these technical problems, 14 (93%) of 16 fractures achieved union. Applying Herbert's criteria, a satisfactory rating for clinical function was achieved in 59% of all patients and for patient satisfaction in 68% of all patients. Although the postoperative immobilization period was reduced using the screw, the final functional result in our nonunions was similar to that reported for the Russe bone grafting procedure. Appropriate modifications of the standard technique and recognition of equipment limitations may improve union rates.

Adolescent↗
PubMed2001

[Trauma of the bones of the hand and wrist].

Fractures of the distal radius are common counting for 17 percent of all fractures. With conventional radiography they can be classified readily. Magnetic resonance imaging (MRI) is a suitable technique for the detection of occult forms of fractures and of associated soft tissue injuries. In the wrist, fractures are 10 times less common than in the distal radius, with the scaphoid bone to be involved most commonly. Indications for computed tomography (CT) are complex fractures, occult fractures, or dislocations. MRI should be performed to evaluate the soft tissues, to detect occult fractures, or to analyse osteochondral lesions. Indications for arthrography are injuries of the ligaments or of the joint capsule. Fractures and dislocations of the metacarpal, and the phalangeal bones are the most common fractures of the skeletal system. Conventional radiography is the primary imaging technique, followed by sonography and MRI to detect injuries of the ligaments and tendons.

Austria↗
PubMed1991

Diagnostic value of ultrasound in scaphoid fractures.

Diagnostic ultrasound was used in 103 patients with a clinically suspected fracture of the scaphoid bone in order to achieve an early diagnosis. There were 48 women and 55 men aged 10-75 years (mean 31.4 years) tested with ultrasound. Of the patients, 72 were tested within 3 days after injury the remainder between 4 and 42 days. Fracture was confirmed radiologically in 27. We found that the ultrasound test, applied with a frequency of 1 MHz and intensity of 0.5 W/cm2 and 2.0 W/cm2 for 30s, had a sensitivity of 37 per cent and a specificity of 61 per cent. We thus conclude that ultrasound is not suitable for early diagnosis of scaphoid fracture.

Adolescent↗
PubMed1985

Clinical fracture of the carpal scaphoid--an illusionary diagnosis.

The management of patients with clinical evidence of a fracture of the carpal scaphoid bone but without radiological evidence of a fracture is based on dogma emphasizing the need to immobilize the wrist in all cases. Because of the apparently high proportion of patients who spend up to six weeks in a plaster cast and in whom no fracture is ever demonstrated radiologically, a study was undertaken to determine the fate of those wrist injuries diagnosed as clinical fractures of the scaphoid. All patients who presented with clinical or radiological evidence of fractures of the scaphoid over a one year period were reviewed. Of the 108 patients in whom the diagnosis of clinical fracture of the scaphoid was made at the time of presentation none was proved radiologically to have a fracture of the scaphoid subsequently after a period of mobilization. These patients spent an average time of 21.9 days in a plaster cast which represents a significant loss of productivity to the community and inconvenience to the patient.

Adolescent↗
PubMed1989

The anatomical fat pad and the radiological "scaphoid fat stripe".

The diagnostic value of the "scaphoid fat stripe" seen on X-rays in association with fractures of the scaphoid bone in the wrist is reviewed. The anatomical basis for these soft tissue radiological changes was investigated by dissection of the anatomical snuff-box and by injection studies. It is concluded that the snuffbox fat is part of a major fat-pad located in a recess radio-dorsally on the wrist. However the radiological structure named the "scaphoid fat stripe" was found to be the highly radiolucent common tendon sheath of the extensor pollicis brevis and the abductor pollicis longus muscles. Limitations in diagnostic sensitivity and specificity are discussed.

Adipose Tissue↗
PubMed1984

Swanson trapezial implant in the treatment of peritrapezial arthrosis. A study of eighty cases.

Eighty cases of peritrapezial arthritis of the thumb treated by Swanson's trapezial implant have been reviewed by the authors. They advocate a slightly modified technique and emphasize the importance of "varisation" of the implant and of correct resection of the greater multangular bone. Follow-up was at least one year in all cases, maximum 10 years, the mean being 3 1/2 years. Results were judged as very good in 75% of the cases, fair in 20% and poor in 5%. This study emphasized the cases of failure by implant instability and its causes. In 8 cases, abnormal wear of the implant or of the scaphoid bone raises the question of long-term tolerance of silicone implants.

Arthritis↗
PubMed1984

The natural history of scaphoid non-union.

We reviewed the clinical and roentgenographic findings of forty-seven non-unions of a fracture of the scaphoid in forty-six symptomatic patients in order to assess the incidence and severity of degenerative changes of the wrist. The duration of non-union ranged from five to fifty-three years. Three roentgenographic patterns were seen: twenty-three lesions had sclerosis, cyst formation, or resorptive changes confined to the scaphoid bone (Group I); fourteen had radioscaphoid arthritis (Group II); and ten had generalized arthritis of the wrist (Group III). The duration of Group-I non-unions averaged 8.2 years; Group-II, 17.0 years; and Group-III non-unions, 31.6 years. Fracture displacement and carpal instability correlated with the severity of degenerative changes. Lunate dorsiflexion of 10 degrees or more was a useful guide to carpal instability. Few of the forty-seven non-unions were undisplaced, stable, or free of arthritis after ten years. Based on the high probability of arthritis, we recommend that all displaced ununited scaphoid fractures be reduced and grafted, regardless of symptoms, before degenerative changes occur. Asymptomatic patients with an undisplaced, stable non-union should be advised of the possibility of late degenerative changes.

Arthritis↗
PubMed2006

Dorsal distal radius vascularized pedicled bone grafts for scaphoid nonunions.

Fractures of the scaphoid, particularly its proximal pole, are at risk of progressing to nonunion because of the tenuous, retrograde blood supply. The overall incidence of scaphoid fractures developing nonunion ranges from 10% to 15%, whereas proximal pole fractures of the scaphoid can have up to a 30% incidence of nonunion. Avascular necrosis of these proximal pole fractures can occur in 14% to 39% of cases. Dorsal distal radius vascularized pedicled bone grafting is an alternative to conventional measures for the treatment of displaced proximal pole fractures, established nonunions, and avascular necrosis of the proximal fragment. This graft is based on the 1,2-intercompartmental supraretinacular artery, which has reliable anatomy and predictable course between the first and second extensor compartments. The graft can be harvested and inset into the prepared fracture site using a single-incision approach. The indications, contraindications, technique, and results of treatment are reviewed and detailed.

Bone Transplantation↗