Re: Malizos et al. longstanding nonunions of scaphoid fractures with bone loss: successful reconstruction with vascularized bone grafts.
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Bone Transplantation↗
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[Treatment of scaphoid nonunion with bone flap pedicled on the recurrent branch of radial artery to the styloid process].
OBJECTIVE: To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion. METHODS: From March 2000 to June 2005, the procedure was done in 18 patients with scaphoid nonunion, a small bone flap (1.5 cm x 3.5 cm x 0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients, among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degeneration at fracture end and obviously widening fracture line. RESULTS: The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was 4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day. CONCLUSION: Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.
Adolescent↗
[Extrinsic and intrinsic vascularization of the scaphoid and lunate bones].
This work was performed on 50 wrist dissections. The scaphoid is situated in the territory of the radial artery. Two extracapsular vascular pedicles are constant: --the lateral pedicle arises in the anatomical snuff-box, --the anterior pedicle arises in the "wrist pulse" area and passes behind the flexor carpi radialis. It lies on the radio-carpal ligaments. THe intra-capsular pedicles approach the scaphoid from its proximal pole. There are anastomoses and they lie on the deep dorsal and palmar ligaments. The multiple anastomotic branches may form an inconstant pedicle. The lunate is supplied by frequent but inconstant arterial pedicles. They are palmar and dorsal, superficial and deep (intra-capsular), distal and proximal, and lie on the radiocarpal ligaments. They originate from the three principal arteries of the hand or their branches. Anastomotic connections exist between them; if the vascular arrangement is complete, it is very reliable; when it is incomplete, it predisposes to Kienböck's disease. There is a close functional relationship between the scaphoid and the lunate. The vulnerability of these two bones to trauma which can also affect their ligaments explains the relative frequency of ischemic complications.
Carpal Bones↗
Arthrosis in the peritrapezial joints of the hand.
In the present study saddle joints of the thumb and neighboring joints of 100 anatomic specimens are examined with regard to radiological and macroscopic arthrotic alterations. Comparisons of radiological and macroscopic findings demonstrate that early arthrotic articular alterations cannot be diagnosed radiologically. Almost half of the hands examined displayed arthrotic lesions in the saddle joint of the thumb, whereas the trapezoido-scaphoidal and trapezio-scaphoidal joints are each affected in one third. Hands with manifest thumb saddle joint arthrosis are accompanied by arthrotic alterations of the joints between the scaphoid, trapezium and trapezoid in two-thirds of the cases. In the remaining radial intercarpal joints, no macroscopic evidence can be ascertained of arthrotic alterations. Among the processes discussed as causal factors of simultaneous incidence of scaphoidal and carpo-metacarpal arthroses, the architecture of the osseous carpus, the individual expression of the scaphoid bone and poly- or secondary arthrotic processes are important.
Adult↗
Silastic scaphoid implants in osteoarthritis of the radioscaphoid joint.
The long term results of Silastic Scaphoid implants are presented in two groups of patients, with osteoarthritis of the radioscaphoid joint without known history of trauma or established pseudarthrosis of the scaphoid bone. The patients in the former group all became satisfied with the operative result whereas in the latter group only half of the patients were satisfied with the result.
Adult↗
Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions.
Most nonunions of the carpal scaphoid bone can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Nine patients with nonunion and three patients with unstable proximal pole fractures were treated with retrograde dorsal Herbert screw fixation and adjunctive bone grafting. Follow-up averaged 25 months. Of the 12 patients, the fracture healed in 11 and one fracture remained ununited. This technique has been successful in our practice and should be considered in the treatment of small proximal pole nonunions and displaced proximal pole fractures.
Adolescent↗
Arthroscopic assessment of the volar region of the scapholunate interosseous ligament through a volar portal.
PURPOSE: The volar region of the scapholunate interosseous ligament is one of the key structures that maintains scapholunate alignment. It is, however, difficult to evaluate this ligament using standard diagnostic procedures, including the arthroscopy through a dorsal portal. We have performed arthroscopic evaluation of this ligament through a volar portal. METHODS: Skin incision was made at just radial of the flexor carpi radialis tendon and the portal was opened through the tendon sheath. RESULTS: The volar approach enabled us to directly observe the extent of the tear of the volar region of scapholunate interosseous ligament. A shaver is inserted through the dorsal portal, and debridement can be performed by using the volar portal vein. We have not had any complications using volar portal. CONCLUSION: Volar approach is a feasible and safe procedure to evaluate and treat the volar region of the scapholunate interosseous ligament.
Arthroscopy↗
[Relation of necrosis to outcome and site of fracture in scaphoid pseudarthrosis].
Usually, untreated scaphoid fractures lead to non-union and partial or complete avascular necrosis. The purpose of our study was to examine the influence of location and fracture line on the pattern of necrosis. Therefore, 85 patients with scaphoid non-union were examined by enhanced highfield MRI. Fractures were classified by location and fracture line. A staging system based on signal intensity in T1-weighted spin-echo sequences in enhanced MRI was used to evaluate extent and location of avascular necrosis, which was found in 81% of our patients. In our patients, viability of the scaphoid was independent of the fracture line without dominance of vertical oblique fractures (2%). Based on our staging system, signal intensity as a sign of fragment viability was reduced in the proximal fragment in 46 patients, whereas in eight patients the distal fragment showed reduced viability. In 26 patients, no difference was found between proximal and distal fragments. Fractures proximal to the transition of middle to distal third showed less viability of the proximal fragment, not dependent of how proximal the fracture was seen. In triple fractures (6%) signal intensity of scaphoid bone was more reduced in enhanced MRI.
Adult↗
Extensor indicis brevis: a rare anatomical variation.
We describe a rare anatomical variant, the extensor indicis brevis--a "short" index extensor originating from the ligament over the scaphoid bone. In our patient it presented as a tender mass. The knowledge of such anatomical variations is important in diagnosing dorsal hand masses and in planning tendon transfers.
Adolescent↗
Nonunion of a carpal scaphoid fracture in a child.
We report a case of a nonunion of a carpal scaphoid in a child treated successfully by cast immobilization. Contrary to the general opinion that nonunion of the scaphoid bone should be treated operatively, even in children, we showed that healing can be obtained by nonoperative treatment methods.
Carpal Bones↗
Spatial resolution requirements in digital radiography of scaphoid fractures. An ROC analysis.
PURPOSE: To investigate the spatial resolution requirements in digital radiography of scaphoid fractures. MATERIAL AND METHODS: Included in the study were 60 scaphoid radiographs with and 60 without fractures of the scaphoid bone. The film-screen images were digitized using pixel sizes of 115, 170, and 340 microns along with 170 microns with a 10:1 wavelet compression. The digital images were displayed on a 1280 x 1024 x 8 bits monitor, and 5 observers evaluated the images in 5 randomized sessions. The results for each pixel size were then compared to the film-screen images by ROC analysis. RESULTS: The mean area under the ROC curves was larger for the film-screen images than for the digital images at all resolutions. However, this difference was not significant when the areas under the ROC curves for the film-screen images were compared to the digital images of 115, 170, and 170 microns with 10:1 compression. There was a significant difference for the 340-microns pixel size in favour of the film-screen images. The mean ROC curves for the digital images were very similar for the 115 and 170 microns pixel sizes, although slightly better for 115 microns. At 170 microns, the compression seemed to have a relatively small negative effect on the diagnostic performance; the deterioration was greater when the pixel size was increased to 340 microns. There was no obvious correlation between diagnostic performance and the experience of the observers in using work-stations. CONCLUSIONS: The pixel size of 170 microns is adequate for the detection of subtle fractures, even after wavelet compression by a ratio of 10:1.
Angiography, Digital Subtraction↗
Closed dislocation of the scaphoid. A case report and review of the literature.
A case of traumatic dislocation of the scaphoid bone treated by open reduction is reported. The bone remained vital, being nourished by a slender connection to the surrounding tissue. Experience from the few cases reported in the literature shows that closed reduction is often successful. If surgery is necessary it seems that it should be limited to simple reduction of the dislocation and that there is no need for primary arthrodesis or arthroplasty. Stable fixation is necessary to avoid re-dislocation and later wrist instability.
Aged↗
Ultrasonography in detection of effusion in the radiocarpal and midcarpal joints.
Sixty radiocarpal and midcarpal joints in 30 healthy adults and 20 swollen wrists in 20 patients with chronic arthritis were examined by dorsal longitudinal ultrasonography (US). In five other patients intraarticular application of fluid into the radiocarpal joint could be seen as a change in the US scan. In 49 out of the 60 healthy wrists the unechogenic zone dorsally above the scaphoid bone was less than two millimetres, and the measurement did not change in dorsal or volar flexion. The side difference was less than one millimetre. In the healthy wrists the midcarpal area above bones was echogenic in US. In 15 radiocarpal and in 10 midcarpal joints out of the 20 swollen wrists, effusion could be depicted with US as an unechogenic zone. It was two millimetres or more in radiocarpal joint and it got bigger in dorsal and smaller in volar flexion.
Adolescent↗
Denervation of the wrist joint--an alternative in conditions of chronic pain.
Nine patients with chronic pain in the wrist secondary to lunatomalacia and non-union of the scaphoid bone were treated by denervation of the wrist joint. This operation was first presented by Wilhelm in 1966. We have been using a modified technique. The purpose of the operation is to achieve relief of pain by selective neurotomy without impairment of hand function and with preservation of wrist mobility. Eight patients were considerably improved; one was not helped at all. No appreciable progression of the pathological changes have occurred radiographically during the period of follow-up. We find our results encouraging and the method worth trying.
Adult↗
[Method of compression arthrodesis of the ankle and foot joints].
A modified F.R. Bogdanov arthrodesis of the talocrural joint is described. The authors employed an external compression with three Kirschner pins, inserted in the tibial, calcanial and scaphoid bones. Late results of the operation were followed up in 20 patients. A complete correction, osteoankylosis of arthrodesized joints and rehabilitation of the weight-bearing function of the foot and extremity, as a whole, were gained in all patients.
Adolescent↗
Dislocation of the carpal lunate and navicular bones.
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Carpal Bones↗
[Arthroscopy in the diagnosis and therapy of wrist disorders].
PURPOSE OF THE STUDY: Arthroscopy of the wrist is a method facilitating the establishment of diagnosis in patients with wrist complaints which may also serve for surgical management of some of the causes of wrist pathology. The author presents his first experience with carpal arthroscopy as a diagnostic method as well as a therapeutic technique performed in one or two stages. MATERIAL: A total of 34 patients, 12 women and 22 men, in the age range of 14 to 64 years, underwent carpal arthroscopy. This was performed to treat acute or chronic conditions in 16 and 18 patients, respectively. METHODS: Arthroscopy was carried out with the hand in vertical traction, using distraction forces of 50 to 70 N, from the approach between the third and fourth or/and the fourth and fifth extensor compartments, in order to inspect the mediocarpal joint by an arthroscope with a diameter of 2.4 mm. Neither a tourniquet nor a pump was employed. When a lesion was detected, it was treated by arthroscopy or an open procedure in one surgical procedure. When indicated, further surgical intervention followed. RESULTS: The arthroscopic inspection revealed triangular fibrocartilagenous complex (TFCC) lesions in 18 patients. Injury to the scaphoid-lunate (SL) ligament was found in 16 patients. One patient had a combined lesion of the triquetral-lunate and SL ligaments, two showed a SL lesion together with a distal radius fracture, three were diagnosed with pseudoarthrosis of the scaphoid bone and one with synovitis after rheumatoid arthritis. In two patients, adhesions in the radiocarpal joint following a fracture of the distal radius were found and shaved. A total of 22 patients were treated by arthroscopic surgery; 19 underwent open procedures in one stage and five were indicated for secondary surgery. DISCUSSION: Wrist arthroscopy has been reported in the literature as the only method that can reveal damage to SL ligaments not shown by X-ray or magnetic resonance imaging examination. During arthroscopy, several interventions can directly be carried out by this procedure, such as treatment of the TFCC, and thus relieve the patient's complaints. Arthroscopy is irreplaceable in the diagnosis of dynamic carpal instability or injury to TFCC in ulnar-carpal impingement. Our experience suggests that arthroscopically-guided osteosynthesis of the distal radius has great prospects. CONCLUSIONS: In our hospital acute arthroscopy is indicated when carpal connective tissue lesions, potentially leading to wrist instability, are suspected, when damage to carpal ligaments is found by X-ray examination or when an acute TFCC lesion is suspected. Arthroscopically-guided osteosynthesis of the distal radius appears to be a prospective method. In patients with chronic complaints, wrist arthroscopy is indicated in suspected TFCC lesions with ulnar-carpal impingement, in chronic carpal synovitis, and before sperious operations on the carpal bones in order to ascertain the state of cartilage and plan the appropriate surgery.
Adolescent↗
A new surgical technique for carpal instability with scapholunate dissociation.
The most common carpal instability is the scapholunate dissociation (carpal instability dissociative: C.I.D.) with dorsal intercalated segment instability (D.I.S.I.), with the most significant element being the flexion of the scaphoid bone (rotary subluxation). Rupture of the scapholunate ligament was formerly believed to be the prerequisite for the dissociation.':' However, three findings contradict this theory"':
Journal Article↗