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PubMed1999

Intraosseous ganglia of the scaphoid and lunate bones: report of 15 cases in 13 patients.

Thirteen patients with 15 intraosseous carpal ganglia (6 scaphoid and 9 lunate cases) are reported. Eleven cases had cortical defects communicating the bone cysts either with the joint space or a coexisting soft tissue ganglion. Nine cysts were primary or idiopathic; soft tissue ganglia were found in 6 secondary cases and anatomic continuity of the intraosseous and extraosseous components through cortical defects was present. Treatment consisted of curettage of the cyst wall and cancellous bone grafting. Approaching lunate cysts through a small opening in the scapholunate interosseous ligament is described. Results were analyzed in 12 cases with at least 1 year of follow-up; the average follow-up period in these cases was 47 months (range, 12-119 months). Results were very good in all but 1 patient, who suffered a partial lunate collapse, which resulted in mild lunocapitate osteoarthritis. No graft reabsorption or recurrence was seen in the control radiographs obtained throughout the follow-up period.

Adult↗
PubMed1981

Isotope bone imaging in suspected scaphoid trauma.

The unreliability of radiological examination in excluding or confirming a suspected scaphoid fracture after carpal trauma is a well-recognised diagnostic problem. This paper explores the role of isotope bone imaging (IBI) in the early identification of carpal bone injury. Abnormal generalized uptake of activity may be seen within the carpus, possibly as a consequence of diffuse soft tissue injury, particularly if imaging is performed within 48 hours of trauma. A focal area of increased uptake related to one carpal bone is suggestive of fracture though the part which ligamentous injury, localized periosteal reaction or incomplete cortical infarction may play in the production of such radionuclide appearances is uncertain. Ninety-nine patients with suspected recent scaphoid fracture but no demonstrable abnormality on radiological examination were subjected to IBI, using 555 MBq (15 mCi) of 99Tcm methylene diphosphonate. Abnormal focal increased uptake (AFIU) was found in 47 patients, this being localized to the scaphoid bone in 26. Of these 47 cases, 19 (42%) showed subsequent radiological evidence of fracture. The results of IBI, in our experience, can only be reliably interpreted if imaging is performed at least 48 hours after injury, though in cases of fracture AFIU may persist for several years. Using this technique, the possibility of fracture can be confidently excluded in that group of patients who show no AFIU. In selected cases of carpal trauma, IBI provides a satisfactory alternative means of identifying the presence and site of localized injury within the carpus and may be used to confidently exclude those patients with non-osseous symptomatology.

Adolescent↗
PubMed1999

Techniques for Vascularised Bone Grafting in Scaphoid Nonunion.

Nonunion of the scaphoid remains a significant problem in the management of scaphoid fractures. Recurrent persistent nonunion following attempts at internal fixation, and nonunions with sclerosis or avascular necrosis of the proximal pole of the scaphoid are particularly challenging. However, the aims of restoration of scaphoid anatomy and the achievement of union of the scaphoid remain the foundation pillars of scaphoid treatment. In recent years, several techniques for using vascularised bone grafts in the treatment of these difficult problems have been described. This article will review the currently described treatments, provide an overview of our unit experience with these techniques, and also describe a technique for in situ vascularisation of a conventional bone graft.

Journal Article↗
PubMed1992

CT of the wrist in suspected scaphoid fracture.

Bone scan and sagittal projection CT of the scaphoid was performed in 10 patients with clinically suspected scaphoid fractures. The primary and follow-up plain radiographs were negative or equivocal for fracture. CT examination demonstrated scaphoid fracture in 7 patients and normal findings in 3. It is concluded that CT of the scaphoid can replace bone scan to diagnose or rule out fracture in institutions where nuclear medicine facilities are not available.

Adolescent↗
PubMed1990

Diagnostic problems of scaphoid fractures: the value of radionuclide bone scintigraphy.

The diagnosis fracture of the scaphoid bone based on mere X-ray examination is unreliable. A correct diagnosis of scaphoid fractures is essential for the prevention of avascular necrosis of the proximal fragment and of pseudo-arthrosis. Thirty-three patients with a clinically suspected scaphoid fracture and a normal radiograph were examined. These patients had supplementary 99mTc-MDP scintigraphy. Eight of the 33 patients had normal scans, 12 patients had a scaphoid fracture and 17 had other fractures. Based on our findings, radionuclide bone scintigraphy is useful and accurate for the diagnosis or exclusion of fractures of the scaphoid and other carpal bones.

Adult↗
PubMed2004

Vascularized bone graft for scaphoid nonunions.

Scaphoid fracture nonunion remains a challenging problem that may persist despite traditional methods of bone grafting and internal fixation. The alteration of wrist mechanics created by nonunion as well as the development of avascular necrosis leads to degenerative change of the radiocarpal joint accompanied by loss of motion and pain. The use of a vascularized bone graft has the theoretical benefit of increased blood flow that exceeds that of nonvascularized grafts. Numerous sources of vascularized bone graft have been described, including those from remote sites as well as from the carpus and distal radius. Knowledge of the blood supply to the distal radius has allowed for development of several vascularized bone graft harvest sites. The results of vascularized bone grafting from the distal radius have been encouraging, with numerous authors reporting the successful treatment of scaphoid nonunions.

Journal Article↗
PubMed1987

Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid.

A bone graft, taken from the medial part of the radial epiphysis can be pedicled on the radial branch of the volar carpal arch, freed back to its origin. The graft can be transferred into the proximal row of the carpus to fill up a loss of bony substance or to provide vascularised bone. This permits the treatment of chronic pseud-arthrosis of the scaphoid where a Matti-Russe operation has failed. In the first three cases operated upon, favourable results have been obtained.

Adult↗
PubMed1995

The suspected scaphoid fracture and isotope bone imaging.

Carpal trauma often results in scaphoid injury. A small group of patients have clinical evidence of scaphoid fracture but radiographs fail to demonstrate bony damage. Persistent pain warrants isotope bone scanning. This report reviews the results of 36 consecutive bone scans performed for the suspected scaphoid injury and reviews radiographs taken on presentation. In all, 18 diagnosed fractures: there were three of the scaphoid, six of the distal radius and nine of other carpal bones. It was possible, with hindsight, to see eight fractures on the original radiographs. In patients with continued pain over the radial side of the carpus, attention should be given to the other carpal bones and the distal radius and not just the scaphoid.

Adolescent↗
PubMed1991

A new vascularized bone graft for scaphoid nonunion.

Nonunion and avascular necrosis after scaphoid fractures continue to be problem sequelae because of unrecognized injuries, inadequate immobilization techniques, or insufficient treatment time. Screw fixation and inlay bone grafting techniques remain the options of choice, with successful union reported in approximately 90% of patients. However, prolonged immobilization with plaster up to 4 to 6 months is required with conventional techniques. With the use of standard latex injection techniques with vascular filling of vessels to less than 0.1 mm diameter in ten fresh cadaver dissections, we discovered a consistent vascularized bone graft source from the distal dorsoradial radius. We have used this vascularized bone graft source with good results in eleven patients with long-standing nonunion of the scaphoid. It is technically easy and seemingly offers the advantages of a decreased period of immobilization and a higher union rate.

Adolescent↗
PubMed2004

Scaphoid nonunions treated with vascularised bone grafts: MRI assessment.

PURPOSE: To assess the value of MR imaging (MRI) with regard to union, graft viability and proximal pole bone marrow status, after use of vascularized bone grafts for treating scaphoid nonunions. MATERIALS AND METHODS: Vascularized bone grafts from the distal radius were used to treat 47 scaphoid nonunions resulting from fractures or enchondromas. Clinical and imaging evaluation was used for the pre- and postoperative assessment of all patients. Apart of conventional radiographs obtained in all cases, 15 patients were also assessed postoperatively with MRI at 3 months. From these 15 patients, eight were assessed preoperatively with MRI whereas nine had serial MRI evaluations at 6 and 12 months. The clinical follow-up time of this subgroup of 15 patients ranged from 6 to 27 months. RESULTS: All patients showed clinical signs of union within 12 weeks form the procedure and at the latest follow-up they experienced complete (10 cases) or almost complete (five cases) relief from pain. Both plain and contrast-enhanced MRI obtained at 3 months showed viability of the bone graft in all cases. At 3 months union was established with plain radiographs in 12 patients at both sides of the graft and in three patients between the graft and proximal pole. At 3 months plain MRI showed nonunion in four patients (two between graft and proximal pole, two between graft and distal pole and one at both sides of the graft) whereas contrast-enhanced MRI revealed only one case of nonunion between graft and proximal pole. Four patients were considered to have osteonecrosis of the proximal pole intraoperatively. Two of them showed necrosis of the proximal pole with preoperative and postoperative plain radiographs and three of them with plain postoperative MRI. Contrast-enhanced MRI at 3 months showed postoperative reversal of necrotic changes in all four scaphoids. MRI also revealed bone marrow oedema of the carpal bones surrounding the scaphoid in 14 cases. Serial MRI at 6 and 12 months, obtained in nine patients, revealed resolution of the bone marrow oedema of the surrounding bones and full graft incorporation in all cases. CONCLUSION: Contrast-enhanced MRI is able to demonstrate the early union after treatment of scaphoid nonunions with vascularised bone grafts allowing thus earlier mobilisation. In addition, MRI can assess the viability of the proximal pole and the graft as well as the postoperative bone marrow oedema-like lesions of the surrounding bones.

Adolescent↗
PubMed2000

Factors influencing the outcome of bone grafting surgery for scaphoid fracture non-union.

The results of a consecutive series of bone-grafting procedures for non-union of scaphoid fractures were assessed in order to investigate whether the patient's age or the delay between acute fracture and bone-graft surgery influenced the outcome. One hundred and thirty-four patients with a mean follow up of 2.6 years from bone-graft surgery for scaphoid fracture non-union were assessed for post-operative pain and radiographic evidence of union. No association was found between the union rate following surgery and either the patients' ages or the interval between the original injury and subsequent non-union surgery.

Adolescent↗
PubMed2002

Use of the 1,2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion.

Fourteen patients with established scaphoid nonunion were treated with vascularized pedicle bone grafting. All nonunions healed at a mean of 11.1 weeks (range, 8-16 weeks). Wrist motion was minimally affected by surgery. Intercarpal and scaphoid angles were improved after surgery, particularly in patients with preoperative humpback deformity who had previous interposition grafting. Outcome, based on a self-assessment questionnaire administered at a mean 30 months of follow-up (range, 19-53 months), showed 2 excellent, 7 good, 4 fair, and 1 poor result. Three patients showed progressive radioscaphoid arthrosis. Vascularized bone grafts are indicated in proximal pole fracture nonunions, in the presence of avascular necrosis, and after conventional grafts. Radiocarpal arthritis, if present before surgery, is a poor prognostic sign.

Adolescent↗
PubMed1993

The value of radiographs and bone scintigraphy in suspected scaphoid fracture. A statistical analysis.

The role of radiography and bone scintigraphy in the diagnostic management of suspected scaphoid fracture is controversial. Two strategies were compared for patients with initial negative radiographs: repeated radiography versus selective bone scintigraphy. Using the known positive predictive value of scintigraphy, the sensitivity and specificity of both diagnostic strategies were evaluated in a series of 78 consecutive patients. The kappa value for initial radiographs was 0.76 but decreased to 0.5 for follow-up radiographs. Similarly, sensitivity decreased from 64% to 30% in follow-up radiographs. Specificity of the bone scan was 98%. The best diagnostic strategy in the management of clinically suspected scaphoid fractures consists of initial radiography followed by bone scintigraphy in patients with negative radiographs.

Adult↗